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 breastfeeding mother should be advised not to breastfeed?

  1. AA mother with mastitis
  2. BA mother with a common cold
  3. CA mother who had a caesarean birth
  4. DA mother receiving chemotherapy
2.Maternity & obstetric nursingHard

A preterm infant receiving oxygen has saturations that are consistently 100%. What should the nurse do?

  1. ALeave it unchanged because 100% is ideal
  2. BWean the oxygen to the target saturation range
  3. CRemove the saturation probe to save the skin
  4. DIncrease the oxygen to provide a safety margin
3.Dosage calculationsMedium
024681010 mL

A child weighing 24 kg is prescribed 4 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

24 kg4 mg/kg20 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 800 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

800 units5000 units/mL
V = mL
5.IV infusion ratesMedium
V = ?60 gtt/mL75 gtt/min12 h

A drip runs at 75 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 12 hours?

75 gtt/min60 gtt/mL12 h
V = mL
6.IV infusion ratesHard
200 mL15 gtt/mL50 gtt/mint = ? h

A drip runs at 50 gtt/min through a set of 15 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty?

50 gtt/min15 gtt/mL200 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: D · A mother receiving chemotherapy

Why this is the answer

Breastfeeding is contraindicated with most cytotoxic chemotherapy, untreated active tuberculosis, use of illicit drugs, and in an infant with galactosaemia. Mastitis and colds are not reasons to stop.

Answer

D · A mother receiving chemotherapy
2.Maternity & obstetric nursing

Answer: B · Wean the oxygen to the target saturation range

Why this is the answer

Hyperoxia increases the risk of retinopathy of prematurity and lung injury. Oxygen is titrated to the prescribed target saturation range rather than to 100%.

Answer

B · Wean the oxygen to the target saturation range
3.Dosage calculations

Answer: V = 4.8 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 = 4·24 = 96 mg

Volume

V = 96/20 = 4.8 mL

On the syringe

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

Answer

V = 4.8 mL
4.Dosage calculations

Answer: V = 0.16 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.

Volume

V = 800/5000 = 0.16 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.16 mL
5.IV infusion rates

Answer: V = 900 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

75·60/60 = 75 mL/h

Volume

V = 75·12 = 900 mL

Answer

V = 900 mL
6.IV infusion rates

Answer: t = 1 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

50·60/15 = 200 mL/h

Time left

t = 200/200 = 1 h

Answer

t = 1 h

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