产科护理
方法
- 把产妇放在时间轴上定位：孕周、产程阶段或产后第几天，再判断此时什么是正常的。
- 找出处于危险中的对象：母亲、胎儿或新生儿，或者其中不止一个。
- 把发现与其原因联系起来：减速用 VEAL CHOP，出血用四个 T，产后用 BUBBLE-HE。
- 优先选择改善血流和氧合的措施（侧卧、停用缩宫素、宫底按摩），然后再升级处理。
产科护理：速成包
公式表、每个专题的关键方法步骤和 6 道练习题，完整解答附在最后。
1公式与方法
剂量计算
- 由浓度计算剂量
- 体积 = 剂量 / 浓度
- 按体重给药
- 剂量 = mg/kg × 体重
- 片剂
- 片数 = 剂量 / 每片规格
- 单位
- 1 g = 1000 mg, 1 mg = 1000 mcg
方法
- 把医嘱剂量和药品规格换算为同一单位。
- 用“需要量除以现有量再乘以数量”：(D/H) × Q。
- 按体重给药时，先乘以以 kg 计的体重，再用日剂量除以给药次数。
- 先估算，再检查答案是否合理。
静脉输液速度
- 泵速
- mL/h = volume (mL)/time (h)
- 滴速
- drops/min = volume (mL) × drop factor / time (min)
- 输注时间
- time (h) = volume (mL)/rate (mL/h)
方法
- 泵速 mL/h：体积除以以小时计的时间。
- 滴速 drops/min：体积 × 滴系数，再除以以分钟计的时间。
- 剩余时间：剩余体积除以速率。
- 按题目或设备的要求取整。
2练习题
1.产科护理中等
Which feature best distinguishes true labour from false labour?
- AContractions that are felt only in the lower abdomen
- BDiscomfort that eases with a warm bath and rest
- CProgressive dilation and effacement of the cervix
- DContractions that stop when the woman walks around
2.产科护理困难
A woman at 31 weeks with contractions has a negative fetal fibronectin test. What does this result mean?
- ABirth within the next 1 to 2 weeks is unlikely
- BBirth will certainly occur within 48 hours
- CThe fetus has an infection
- DThe membranes have ruptured
3.剂量计算中等
一名体重 40 kg 的患者体表面积为 1.27 m²。医嘱为 250 mg/m²。求剂量 D，以 mg 表示。
40 kgBSA = 1.27 m²250 mg/m²
D = mg
4.剂量计算困难
一袋输液在 500 mL 中含 50000 单位药物。医嘱为每小时 2000 单位。泵速 R 应设为多少 mL/h？
50000 件/500 mL2000 件/h
R = mL/h
5.静脉输液速度中等
医嘱要求以 75 mL/h 输液，但没有输液泵。改用滴系数为 60 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
75 mL/h60 gtt/mL
R = gtt/min
6.静脉输液速度困难
医嘱要求在 6 小时内输入 500 mL。4 小时后你发现袋中还剩 210 mL，而输液仍须按时完成。 原来的泵速必须提高百分之多少 Δ？
500 mL / 6 h经过 4 h: 210 mL
Δ = %
3溶液
1.产科护理
答案: C · Progressive dilation and effacement of the cervix
为什么是这个答案
True labour causes progressive cervical change. Its contractions become regular, stronger and closer and do not stop with rest or walking. False labour contractions are irregular and ease with rest or position change.
答案
C · Progressive dilation and effacement of the cervix
2.产科护理
答案: A · Birth within the next 1 to 2 weeks is unlikely
为什么是这个答案
Fetal fibronectin is a protein that binds the membranes to the uterine lining. A negative result has a high negative predictive value, meaning birth within 7 to 14 days is unlikely; a positive result is less predictive.
答案
A · Birth within the next 1 to 2 weeks is unlikely
3.剂量计算
答案: D = 317.5 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
剂量
D = 250·1.27 = 317.5 mg
答案
D = 317.5 mg
4.剂量计算
答案: R = 20 mL/h
剂量计算：给药量等于医嘱剂量除以现有药物的规格，再乘以该规格对应的量：给药量 = (医嘱剂量/储备规格) × 储备体积。始终统一单位（先把 g 换成 mg，mg 换成 mcg），并检查答案是否合理。
浓度
50000/500 = 100 件/mL
泵速
R = 2000/100 = 20 mL/h
答案
R = 20 mL/h
5.静脉输液速度
答案: R = 75 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
每分钟毫升数
75/60 = 1.25 mL/min
滴速
R = 1.25·60 = 75 gtt/min
答案
R = 75 gtt/min
使用微滴输液器（60 gtt/mL）时，gtt/min 等于 mL/h。
6.静脉输液速度
答案: Δ = 26 %
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
原速率
500/6 = 83.33 mL/h
新速率
R = 210/2 = 105 mL/h
变化百分比
Δ = (105 − 83.33)/83.33·100% = 26%
答案
Δ = 26%
这超过了 25% 的增幅：大多数医院要求你联系开医嘱者，而不是加快补输，并评估患者是否存在液体过多。
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