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
How does breast milk jaundice usually differ from early breastfeeding jaundice?
- AIt appears in the first 24 hours in a sick baby
- BIt is caused by too little milk intake
- CIt appears later, after the first week, in a thriving baby
- DIt always needs the baby to stop breastfeeding permanently
2.产科护理困难
A newborn's heart rate is 80/min after 30 seconds of positive-pressure ventilation and the chest is not moving. What should the nurse do next?
- ACorrect the ventilation, starting with mask and airway
- BGive IV adrenaline straight away
- CStart chest compressions immediately at a 3:1 ratio
- DStop ventilation and give oxygen by mask only
3.剂量计算中等
需要从 0.5%（w/v）溶液中取 12.5 mg 的剂量。多少容量 V 含有这一剂量？
12.5 mg0.5% w/v
V = mL
4.剂量计算困难
处方为 4050 单位的药物，药液规格为 5000 单位/mL。请用 1 mL 注射器抽取剂量：应给多少体积 V？
4050 units5000 units/mL
V = mL
5.静脉输液速度中等
滴注以 25 gtt/min 的速度通过滴系数为 20 gtt/mL 的输液器。患者在 6 小时内接受多少毫升 V？
25 gtt/min20 gtt/mL6 h
V = mL
6.静脉输液速度困难
一组输液以 28 滴/分的速度经 15 滴/mL 的输液器滴注。袋中还剩 450 mL。还需多少小时 t 才会滴完？ 保留一位小数。
28 gtt/min15 gtt/mL450 mL
t = h
3溶液
1.产科护理
答案: C · It appears later, after the first week, in a thriving baby
为什么是这个答案
Breast milk jaundice begins after the first week and can last several weeks in an otherwise healthy, well-fed baby. It is thought to be caused by substances in milk and rarely needs breastfeeding to stop.
答案
C · It appears later, after the first week, in a thriving baby
2.产科护理
答案: A · Correct the ventilation, starting with mask and airway
为什么是这个答案
If the chest does not rise, ventilation is ineffective. Corrective steps include adjusting the mask seal, repositioning the head, suctioning, opening the mouth and increasing pressure. Compressions start only if the heart rate stays under 60/min with effective ventilation.
答案
A · Correct the ventilation, starting with mask and airway
3.剂量计算
答案: V = 2.5 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
0.5% = 5 mg/mL
体积
V = 12.5/5 = 2.5 mL
答案
V = 2.5 mL
4.剂量计算
答案: V = 0.81 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 = 4050/5000 = 0.81 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 = 0.81 mL
5.静脉输液速度
答案: V = 450 mL
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.
速度（mL/h）
25·60/20 = 75 mL/h
体积
V = 75·6 = 450 mL
答案
V = 450 mL
6.静脉输液速度
答案: t = 4 h
输注速率：输液泵按 mL/h = 体积/时间（小时）设定。重力滴注按每分钟滴数计：gtt/min = 体积 (mL) × 滴系数 (gtt/mL)/时间 (min)。 滴系数印在输液器包装上：普通输液器为 10、15 或 20 gtt/mL（输血器在美国常为 10 gtt/mL，在英国为 15），微量输液器为 60 gtt/mL。务必使用题目或包装给出的滴系数。
速度（mL/h）
28·60/15 = 112 mL/h
剩余时间
t = 450/112 = 4.018 ≈ 4 h
答案
t = 4 h
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