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

At 1 minute, a newborn's heart rate is 90/min. How many points does the heart rate receive in the APGAR score?

  1. A0
  2. B1
  3. C2
  4. D3
2.Maternity & obstetric nursingHard

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

  1. AOffer oral fluids and check again in an hour
  2. BKeep massaging the fundus firmly on her own for 30 minutes before calling the team
  3. CSit the woman up in high Fowler's position
  4. DCall for help and give the prescribed uterotonic, such as oxytocin, per protocol
3.Dosage calculationsMedium
30 kg20 mg/kg/day3× per dayD = ? mg

A patient weighs 30 kg. The prescribed dose is 20 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

30 kg20 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
25k units1000 mL? mL/h1000 units/h

An infusion contains 25000 units of a drug in 1000 mL. The prescription is 1000 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/1000 mL1000 units/h
R = mL/h
5.IV infusion ratesMedium
V = ?20 gtt/mL50 gtt/min2 h

A drip runs at 50 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 2 hours?

50 gtt/min20 gtt/mL2 h
V = mL
6.IV infusion ratesHard
300 mL15 gtt/mL40 gtt/mint = ? h

A drip runs at 40 gtt/min through a set of 15 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

40 gtt/min15 gtt/mL300 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: B · 1

Why this is the answer

Heart rate scores 0 if absent, 1 if below 100/min and 2 if 100/min or more. Each of the five APGAR signs scores 0–2, so the maximum per sign is 2.

Answer

B · 1
2.Maternity & obstetric nursing

Answer: D · 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

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

Answer: D = 200 mg

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.

Total per day

20·30 = 600 mg

Per dose

D = 600/3 = 200 mg

Answer

D = 200 mg
4.Dosage calculations

Answer: R = 40 mL/h

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.

Concentration

25000/1000 = 25 units/mL

Pump rate

R = 1000/25 = 40 mL/h

Answer

R = 40 mL/h
5.IV infusion rates

Answer: V = 300 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.

Rate in mL/h

50·60/20 = 150 mL/h

Volume

V = 150·2 = 300 mL

Answer

V = 300 mL
6.IV infusion rates

Answer: t = 1.9 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.

Rate in mL/h

40·60/15 = 160 mL/h

Time left

t = 300/160 = 1.875 ≈ 1.9 h

Answer

t = 1.9 h

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