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

The fundus is boggy, above the umbilicus and displaced to the right. What is the most likely cause?

  1. ARetained placental tissue on the left
  2. BA full bladder
  3. CA tear in the perineum
  4. DA normal finding on day 1
2.Maternity & obstetric nursingHard

A woman at 32 weeks with type 1 diabetes has nausea, vomiting, abdominal pain, rapid breathing and a glucose of 16 mmol/L (about 290 mg/dL). Which complication should be suspected?

  1. ANormal pregnancy nausea
  2. BDiabetic ketoacidosis
  3. CHyperemesis gravidarum
  4. DHypoglycaemia
3.Dosage calculationsMedium
024681010 mL

A child weighing 38 kg is prescribed 2 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

38 kg2 mg/kg20 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 850 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?

850 units5000 units/mL
V = mL
5.IV infusion ratesMedium
60 gtt/mL30 mL/h? gtt/min

An infusion is ordered at 30 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

30 mL/h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
1000 mg250 mL15 gtt/mL400 mg/h? gtt/min

1000 mg of a drug is diluted in 250 mL and given by gravity through a set of 15 gtt/mL. The order is 400 mg per hour. Find the drip rate R in drops per minute.

1000 mg/250 mL400 mg/h15 gtt/mL
R = gtt/min

3Solutions

1.Maternity & obstetric nursing

Answer: B · A full bladder

Why this is the answer

A full bladder lifts and displaces the uterus, usually to the right, and stops it contracting well. Helping the woman to empty her bladder usually lets the fundus return to the midline and firm up.

Answer

B · A full bladder
2.Maternity & obstetric nursing

Answer: B · Diabetic ketoacidosis

Why this is the answer

Diabetic ketoacidosis can develop quickly in pregnancy, even at moderately raised glucose, and carries a high risk of fetal death. Ketones and blood gases are checked urgently, and fluids and insulin are started.

Answer

B · Diabetic ketoacidosis
3.Dosage calculations

Answer: V = 3.8 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 = 2·38 = 76 mg

Volume

V = 76/20 = 3.8 mL

On the syringe

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

Answer

V = 3.8 mL
4.Dosage calculations

Answer: V = 0.17 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 = 850/5000 = 0.17 mL

On the syringe

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

Answer

V = 0.17 mL
5.IV infusion rates

Answer: R = 30 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.

Millilitres per minute

30/60 = 0.5 mL/min

Drip rate

R = 0.5·60 = 30 gtt/min

Answer

R = 30 gtt/min

With a microdrip set (60 gtt/mL), gtt/min equals mL/h.

6.IV infusion rates

Answer: R = 25 gtt/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

1000/250 = 4 mg/mL

Volume per hour

400/4 = 100 mL/h

Drip rate

R = 100·15/60 = 25 gtt/min

Answer

R = 25 gtt/min

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