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

An Rh-negative woman has just given birth to an Rh-positive baby. When should anti-D immunoglobulin be given?

  1. ABefore the next pregnancy only
  2. BOnly if the baby develops jaundice
  3. CWithin 72 hours of birth
  4. DWithin 2 weeks of birth
2.Maternity & obstetric nursingHard

After fundal massage, the uterus remains boggy and bleeding is heavy. What is the priority next action?

  1. AKeep massaging the fundus firmly on her own for 30 minutes before calling the team
  2. BCall for help and give the prescribed uterotonic, such as oxytocin, per protocol
  3. COffer oral fluids and check again in an hour
  4. DSit the woman up in high Fowler's position
3.Dosage calculationsMedium
024681010 mL

A child weighing 16 kg is prescribed 20 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?

16 kg20 mg/kg40 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1720 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1720 mcg2 mg/mL
V = mL
5.IV infusion ratesMedium
1000 mL15 gtt/mL6 h? gtt/min

Infuse 1000 mL over 6 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL6 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
200 mg250 mL6 mL/h? mcg/min

An infusion of 200 mg in 250 mL runs at 6 mL/h. How many micrograms per minute D does the patient receive?

200 mg/250 mL6 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: C · Within 72 hours of birth

Why this is the answer

Anti-D is given within 72 hours of the birth of an Rh-positive baby, after a test confirms the mother is not already sensitised. It is not needed if the baby is Rh-negative.

Answer

C · Within 72 hours of birth
2.Maternity & obstetric nursing

Answer: B · Call for help and give the prescribed uterotonic, such as oxytocin, per protocol

Why this is the answer

Ongoing bleeding with poor tone needs immediate escalation and uterotonics, while continuing massage, emptying the bladder, monitoring vital signs, keeping IV access and measuring blood loss. Delaying help is the dangerous option.

Answer

B · Call for help and give the prescribed uterotonic, such as oxytocin, per protocol
3.Dosage calculations

Answer: V = 8 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 = 20·16 = 320 mg

Volume

V = 320/40 = 8 mL

On the syringe

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

Answer

V = 8 mL
4.Dosage calculations

Answer: V = 0.86 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.

Same units

2 mg/mL = 2000 mcg/mL

Volume

V = 1720/2000 = 0.86 mL

Answer

V = 0.86 mL
5.IV infusion rates

Answer: R = 42 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

6·60 = 360 min

Drip rate

R = 1000·15/360 = 41.67 ≈ 42 gtt/min

Answer

R = 42 gtt/min

At the bedside you round to the nearest whole drop: 42 gtt/min.

6.IV infusion rates

Answer: D = 80 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

200000 mcg/250 mL = 800 mcg/mL

Dose per hour

6·800 = 4800 mcg/h

Dose per minute

D = 4800/60 = 80 mcg/min

Answer

D = 80 mcg/min

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