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
Why is it important to do newborn bloodspot screening at the recommended time rather than in the first hours?
- AThe heel cannot be pricked until the cord falls off
- BThe baby's blood cannot be sampled before day 3
- CSome results, such as PKU, need milk feeds first
- DEarlier testing always gives false negatives for all conditions
2.产科护理困难
A labouring woman refuses a recommended caesarean for fetal distress after a full explanation. She has decision-making capacity. What should the nurse do?
- ARespect her decision, document it and inform the team
- BAsk her partner to consent instead
- CStop caring for her because she refused advice
- DPrepare her for surgery anyway because the baby is at risk
3.剂量计算中等
一支肾上腺素预充式注射器标示为 1:10 000（0.1 mg/mL）。医嘱为心脏骤停时 1 mg 静脉注射（IV）。你应给多少体积 V？
1:10 0001 mg
V = mL
4.剂量计算困难
处方为 100 单位的药物，药液规格为 1000 单位/mL。请用 1 mL 注射器抽取剂量：应给多少体积 V？
100 units1000 units/mL
V = mL
5.静脉输液速度中等
医嘱要求以 40 mL/h 输液，但没有输液泵。改用滴系数为 15 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
40 mL/h15 gtt/mL
R = gtt/min
6.静脉输液速度困难
一袋中含有 1 g 药物，溶于 500 mL。医嘱为每分钟 1 mg。泵速 R 应设为多少 mL/h？
1 g/500 mL1 mg/min
R = mL/h
3溶液
1.产科护理
答案: C · Some results, such as PKU, need milk feeds first
为什么是这个答案
Phenylalanine builds up only after the baby has had milk feeds, so very early samples can miss PKU. Programmes specify timing, and early samples may need repeating.
答案
C · Some results, such as PKU, need milk feeds first
2.产科护理
答案: A · Respect her decision, document it and inform the team
为什么是这个答案
A woman with capacity has the right to refuse treatment, even if this may harm the fetus. The nurse ensures she has understood, documents the discussion, continues care and informs the team.
答案
A · Respect her decision, document it and inform the team
3.剂量计算
答案: V = 10 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
浓度
1:10 000 = 1 g/10000 mL = 0.1 mg/mL
体积
V = 1/0.1 = 10 mL
答案
V = 10 mL
美国的标签现在标示 mg/mL（1 mg/mL = 1:1000；0.1 mg/mL = 1:10 000）。切勿静脉推注 1 mg/mL 的肾上腺素。
4.剂量计算
答案: V = 0.1 mL
抽取剂量：体积 = (处方剂量/药物浓度) × 药物体积。先换算成相同的单位，再检查该体积是否适合注射器，并落在它的某一个刻度上。
体积
V = 100/1000 = 0.1 mL
在注射器上
在这支 1 mL 的注射器上，每条小刻度线代表 0.01 mL。
答案
V = 0.1 mL
5.静脉输液速度
答案: R = 10 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
40/60 = 0.6667 mL/min
滴速
R = 0.6667·15 = 10 gtt/min
答案
R = 10 gtt/min
6.静脉输液速度
答案: R = 30 mL/h
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
浓度
1000 mg/500 mL = 2 mg/mL
每小时剂量
1·60 = 60 mg/h
泵速
R = 60/2 = 30 mL/h
答案
R = 30 mL/h
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