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 statement describes the "4 Ts" causes of postpartum haemorrhage?
- ATone, tachycardia, transfusion and tissue
- BTrauma, tension, temperature and thrombosis
- CTone, trauma, tissue and thrombin
- DTemperature, tachycardia, tears and time
2.产科护理困难
After the placenta is delivered, the nurse examines it. Why?
- ATo check that it is complete and nothing is retained
- BTo decide whether the baby needs vitamin K
- CTo check the mother's blood type and Rh factor
- DTo estimate the baby's gestational age from its weight
3.剂量计算中等
20 mL 的 5%（w/v）溶液中含有多少毫克药物 m？
5% w/v20 mL
m = mg
4.剂量计算困难
你需要用 20%（w/v）储备液配制 500 mL 2%（w/v）溶液。 你需要多少容量的储备液 V₁？
C₁ = 20%C₂ = 2%V₂ = 500 mL
V₁ = mL
5.静脉输液速度中等
医嘱要求在 8 小时内输入 1000 mL。3 小时后你发现袋中还剩 810 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？
1000 mL / 8 h经过 3 h: 810 mL
R = mL/h
6.静脉输液速度困难
医嘱要求在 10 小时内输入 1500 mL。3 小时后你发现袋中还剩 1260 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？
1500 mL / 10 h经过 3 h: 1260 mL
Δ = %
3溶液
1.产科护理
答案: C · Tone, trauma, tissue and thrombin
为什么是这个答案
The 4 Ts are tone (atony), trauma (tears, haematomas, rupture), tissue (retained placenta or clots) and thrombin (clotting disorders). Tone is the most common cause.
答案
C · Tone, trauma, tissue and thrombin
2.产科护理
答案: A · To check that it is complete and nothing is retained
为什么是这个答案
The placenta and membranes are inspected for completeness. Retained fragments prevent the uterus contracting and cause postpartum haemorrhage and infection. The number of cord vessels is also checked.
答案
A · To check that it is complete and nothing is retained
3.剂量计算
答案: m = 1000 mg
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
5% = 5 g/100 mL = 50 mg/mL
药物质量
m = 50·20 = 1000 mg
答案
m = 1000 mg
4.剂量计算
答案: V₁ = 50 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.
储备液的容量
V₁ = 2·500/20 = 50 mL
答案
V₁ = 50 mL
5.静脉输液速度
答案: R = 162 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
1000/8 = 125 mL/h
新速率
R = 810/5 = 162 mL/h
答案
R = 162 mL/h
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。
6.静脉输液速度
答案: Δ = 20 %
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 = 1260/7 = 180 mL/h
变化百分比
Δ = (180 − 150)/150·100% = 20%
答案
Δ = 20%
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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