Maternity Nursing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

2Practice problems

1.Maternity & obstetric nursingMedium

Which lochia finding is expected on day 6 after birth?

  1. APink to brownish discharge (lochia serosa)
  2. BNo discharge at all
  3. CBright red discharge with large clots
  4. DGreen, foul-smelling discharge
2.Maternity & obstetric nursingHard

At 7 weeks of pregnancy, a woman reports sudden severe pain on one side of the lower abdomen, pain in the shoulder tip and dizziness. What should the nurse suspect?

  1. AA ruptured ectopic pregnancy with internal bleeding
  2. BNormal round ligament pain caused by the growing uterus
  3. CHyperemesis gravidarum
  4. DBraxton Hicks contractions
3.Dosage calculationsMedium
024681010 mL

A child weighing 20 kg is prescribed 2.5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

20 kg2.5 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
100 mg/5 mLV = ? mL

A child weighing 28 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?

28 kg10 mg/kg100 mg/5 mL
V = mL
5.IV infusion ratesMedium
1500 mL10 gtt/mL3 h? gtt/min

Infuse 1500 mL over 3 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1500 mL3 h10 gtt/mL
R = gtt/min
6.IV infusion ratesHard
100 mg250 mL10 mL/h? mcg/min

An infusion of 100 mg in 250 mL runs at 10 mL/h. How many micrograms per minute D does the patient receive?

100 mg/250 mL10 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: A · Pink to brownish discharge (lochia serosa)

Why this is the answer

Lochia serosa is expected from about day 4 to day 10. Large clots or a return to heavy bright red bleeding suggest retained tissue or subinvolution; a foul smell suggests infection.

Answer

A · Pink to brownish discharge (lochia serosa)
2.Maternity & obstetric nursing

Answer: A · A ruptured ectopic pregnancy with internal bleeding

Why this is the answer

One-sided pain, shoulder-tip pain and dizziness early in pregnancy suggest a ruptured ectopic pregnancy. It is an emergency: monitor vital signs, obtain IV access and get urgent medical help.

Answer

A · A ruptured ectopic pregnancy with internal bleeding
3.Dosage calculations

Answer: V = 2 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Dose from body weight

D = 2.5·20 = 50 mg

Volume

V = 50/25 = 2 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 2 mL
4.Dosage calculations

Answer: V = 14 mL

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Dose from weight

10·28 = 280 mg

Volume

V = (280/100)·5 = 14 mL

Answer

V = 14 mL
5.IV infusion rates

Answer: R = 83 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.

Time in minutes

3·60 = 180 min

Drip rate

R = 1500·10/180 = 83.33 ≈ 83 gtt/min

Answer

R = 83 gtt/min

At the bedside you round to the nearest whole drop: 83 gtt/min.

6.IV infusion rates

Answer: D = 66.67 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).

Concentration

100000 mcg/250 mL = 400 mcg/mL

Dose per hour

10·400 = 4000 mcg/h

Dose per minute

D = 4000/60 = 66.67 mcg/min

Answer

D = 66.67 mcg/min

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