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
A woman says she uses cannabis daily to manage nausea in pregnancy. What is the best nursing response?
- ATell her that cannabis is a natural remedy and safe in pregnancy
- BExplain the risks without judgement and offer safer treatments
- CAdvise her to switch to tobacco instead
- DRefuse to continue her care until she stops
2.产科护理困难
On abdominal palpation, the nurse feels a hard, round, movable mass in the fundus, and the fetal heart is heard above the umbilicus. What does this suggest?
- AA transverse lie with the head in the pelvis
- BA cephalic presentation
- CAn occiput posterior position
- DA breech presentation
3.剂量计算中等
一名体重 24 kg 的儿童按 5 mg/kg 处方用药。原液浓度为 25 mg/mL。请抽取剂量：应给多少体积 V？
24 kg5 mg/kg25 mg/mL
V = mL
4.剂量计算困难
处方剂量为 980 微克。安瓿浓度为 2 mg/mL。请用 1 mL 注射器抽取剂量：应给多少体积 V？
980 mcg2 mg/mL
V = mL
5.静脉输液速度中等
医嘱要求以 120 mL/h 输液，但没有输液泵。改用滴系数为 20 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。
120 mL/h20 gtt/mL
R = gtt/min
6.静脉输液速度困难
400 mg 药物溶于 500 mL 的输液以 20 mL/h 运行。患者每分钟接受多少微克 D？
400 mg/500 mL20 mL/h
D = mcg/min
3溶液
1.产科护理
答案: B · Explain the risks without judgement and offer safer treatments
为什么是这个答案
Cannabis in pregnancy is associated with low birth weight and possible effects on brain development. The nurse discusses the risks without judgement, offers safer antiemetics and support and continues care.
答案
B · Explain the risks without judgement and offer safer treatments
2.产科护理
答案: D · A breech presentation
为什么是这个答案
A hard, round, ballotable head in the fundus means the buttocks are presenting. The fetal heart in breech presentations is usually heard above the umbilicus.
答案
D · A breech presentation
3.剂量计算
答案: V = 4.8 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。
按体重计算剂量
D = 5·24 = 120 mg
体积
V = 120/25 = 4.8 mL
在注射器上
在这支 10 mL 的注射器上，每条小刻度线代表 0.2 mL。
答案
V = 4.8 mL
4.剂量计算
答案: V = 0.49 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
2 mg/mL = 2000 mcg/mL
体积
V = 980/2000 = 0.49 mL
答案
V = 0.49 mL
5.静脉输液速度
答案: R = 40 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
120/60 = 2 mL/min
滴速
R = 2·20 = 40 gtt/min
答案
R = 40 gtt/min
6.静脉输液速度
答案: D = 266.7 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
400000 mcg/500 mL = 800 mcg/mL
每小时剂量
20·800 = 16000 mcg/h
每分钟剂量
D = 16000/60 = 266.7 mcg/min
答案
D = 266.7 mcg/min
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