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 congenital hypothyroidism included in newborn screening?
- AIt can only be treated before birth
- BIt causes jaundice that cannot be treated
- CEarly treatment prevents brain damage
- DIt causes hip dysplasia
2.产科护理困难
A woman on day 2 after a caesarean suddenly has chest pain, breathlessness, a heart rate of 120/min and an oxygen saturation of 90%. What is the priority?
- ATell her to rest and recheck in 4 hours
- BCall for help, sit her up and give oxygen
- CGive her a laxative for abdominal pressure
- DAsk her to walk to the bathroom
3.剂量计算中等
某患者体重 80 kg，医嘱为单次给药 2 mg/kg。求剂量 D（mg）。
80 kg2 mg/kg
D = mg
4.剂量计算困难
处方剂量为 0.69 mg。安瓿每 mL 含 1000 微克。请用 1 mL 注射器抽取剂量：应给多少体积 V？
0.69 mg1000 mcg/mL
V = mL
5.静脉输液速度中等
医嘱要求以 200 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。
200 mL/h15 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 1000 mL。4 小时后你发现袋中还剩 390 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？
1000 mL / 6 h经过 4 h: 390 mL
Δ = %
3溶液
1.产科护理
答案: C · Early treatment prevents brain damage
为什么是这个答案
Untreated congenital hypothyroidism causes poor growth and intellectual disability. Daily levothyroxine started in the first weeks allows normal development.
答案
C · Early treatment prevents brain damage
2.产科护理
答案: B · Call for help, sit her up and give oxygen
为什么是这个答案
Sudden breathlessness, chest pain, tachycardia and hypoxia suggest pulmonary embolism, a leading cause of maternal death. The nurse calls for urgent help, positions her upright, gives oxygen and prepares for investigations and anticoagulation.
答案
B · Call for help, sit her up and give oxygen
3.剂量计算
答案: D = 160 mg
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。
剂量
2·80 = 160 mg
答案
D = 160 mg
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
0.69 mg = 690 mcg
体积
V = 690/1000 = 0.69 mL
答案
V = 0.69 mL
5.静脉输液速度
答案: R = 50 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
200/60 = 3.333 mL/min
滴速
R = 3.333·15 = 50 gtt/min
答案
R = 50 gtt/min
6.静脉输液速度
答案: Δ = 17 %
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
1000/6 = 166.7 mL/h
新速率
R = 390/2 = 195 mL/h
变化百分比
Δ = (195 − 166.7)/166.7·100% = 17%
答案
Δ = 17%
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。
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