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 finding in a term newborn's first hours is normal?
- ACentral cyanosis of the lips and tongue
- BShort breathing pauses with no colour change
- CPauses in breathing of 30 seconds with bradycardia
- DA respiratory rate of 80 at rest with retractions
2.产科护理困难
Which statement by a woman with postnatal depression shows that the nurse's teaching has been effective?
- A"If I take medicine I can never breastfeed again."
- B"I should keep my feelings to myself so I don't worry my family."
- C"Depression after birth means I am a bad mother."
- D"I will tell my midwife or doctor if I have thoughts of harming myself."
3.剂量计算中等
一名体重 35 kg 的儿童按 10 mg/kg 处方用药。原液浓度为 50 mg/mL。请抽取剂量：应给多少体积 V？
35 kg10 mg/kg50 mg/mL
V = mL
4.剂量计算困难
一袋输液在 500 mL 中含 40000 单位药物。医嘱为每小时 1500 单位。泵速 R 应设为多少 mL/h？
40000 件/500 mL1500 件/h
R = mL/h
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 2 小时内接受多少毫升 V？
25 gtt/min20 gtt/mL2 h
V = mL
6.静脉输液速度困难
医嘱要求在 12 小时内输入 1500 mL。6 小时后你发现袋中还剩 830 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 / 12 h经过 6 h: 830 mL
Δ = %
3溶液
1.产科护理
答案: B · Short breathing pauses with no colour change
为什么是这个答案
Newborns breathe irregularly, with short pauses of a few seconds and no change in colour or heart rate. Apnoea of 20 seconds or more, or any pause with cyanosis or bradycardia, is abnormal.
答案
B · Short breathing pauses with no colour change
2.产科护理
答案: D · "I will tell my midwife or doctor if I have thoughts of harming myself."
为什么是这个答案
Teaching aims to reduce shame, encourage support and make clear that thoughts of self-harm must be reported urgently. Many antidepressants are compatible with breastfeeding, and depression is a treatable illness, not a failure.
答案
D · "I will tell my midwife or doctor if I have thoughts of harming myself."
3.剂量计算
答案: V = 7 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 = 10·35 = 350 mg
体积
V = 350/50 = 7 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 = 7 mL
4.剂量计算
答案: R = 18.75 mL/h
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。
浓度
40000/500 = 80 件/mL
泵速
R = 1500/80 = 18.75 mL/h
答案
R = 18.75 mL/h
5.静脉输液速度
答案: V = 150 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 = 75·2 = 150 mL
答案
V = 150 mL
6.静脉输液速度
答案: Δ = 10.67 %
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
1500/12 = 125 mL/h
新速率
R = 830/6 = 138.3 mL/h
变化百分比
Δ = (138.3 − 125)/125·100% = 10.67%
答案
Δ = 10.67%
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。
ExamProblems · examproblems.com/courses/maternity-nursing