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
On abdominal palpation at 39 weeks, only 2/5 of the fetal head can be felt above the pelvic brim. How is this interpreted?
- AThe head is crowning at the vulva
- BThe head is free above the pelvic brim
- CThe fetus is in a breech presentation
- DThe head is engaged in the pelvis
2.产科护理困难
A woman with active genital herpes lesions is admitted in early labour with intact membranes. What should the nurse expect?
- AA fetal scalp electrode for close monitoring
- BA caesarean birth to reduce the risk of neonatal herpes
- CA vaginal birth with no special precautions
- DRupture of the membranes to speed up labour
3.剂量计算中等
一个药瓶中含有 500 mg 的粉末。标签上写着：加入 4.6 mL 注射用水，得到总容量 5 mL。医嘱为 40 mg。你应给予复溶后溶液的多少容量 V？
500 mg+ 4.6 mL → 5 mL40 mg
V = mL
4.剂量计算困难
处方剂量为 345 微克。安瓿浓度为 0.5 mg/mL。请用 1 mL 注射器抽取剂量：应给多少体积 V？
345 mcg0.5 mg/mL
V = mL
5.静脉输液速度中等
医嘱要求在 10 小时内输入 1500 mL。2 小时后你发现袋中还剩 1460 mL，而输液仍须按时完成。 必须把泵重新设定为多少 mL/h 的速率 R？
1500 mL / 10 h经过 2 h: 1460 mL
R = mL/h
6.静脉输液速度困难
200 mg 药物溶于 250 mL 的输液以 24 mL/h 运行。患者每分钟接受多少微克 D？
200 mg/250 mL24 mL/h
D = mcg/min
3溶液
1.产科护理
答案: D · The head is engaged in the pelvis
为什么是这个答案
Descent can be described in fifths of the head palpable above the brim. When 2/5 or less can be felt, the widest part of the head has passed the inlet, so it is engaged; 5/5 palpable means the head is free. Many US units describe descent mainly by station on vaginal examination instead.
答案
D · The head is engaged in the pelvis
2.产科护理
答案: B · A caesarean birth to reduce the risk of neonatal herpes
为什么是这个答案
Active genital lesions or prodromal symptoms at the onset of labour are an indication for caesarean birth because neonatal herpes can be severe. Invasive procedures such as scalp electrodes are avoided.
答案
B · A caesarean birth to reduce the risk of neonatal herpes
3.剂量计算
答案: V = 0.4 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
混合后的浓度
500 mg/5 mL = 100 mg/mL
体积
V = 40/100 = 0.4 mL
答案
V = 0.4 mL
4.剂量计算
答案: V = 0.69 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。
单位相同
0.5 mg/mL = 500 mcg/mL
体积
V = 345/500 = 0.69 mL
答案
V = 0.69 mL
5.静脉输液速度
答案: R = 182.5 mL/h
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
1500/10 = 150 mL/h
新速率
R = 1460/8 = 182.5 mL/h
答案
R = 182.5 mL/h
许多医院允许在不重开医嘱的情况下进行不超过 25% 的此类调整；请查阅本院规定。
6.静脉输液速度
答案: D = 320 mcg/min
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
200000 mcg/250 mL = 800 mcg/mL
每小时剂量
24·800 = 19200 mcg/h
每分钟剂量
D = 19200/60 = 320 mcg/min
答案
D = 320 mcg/min
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