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

A breastfeeding mother asks how she will know her baby is getting enough milk. Which sign is reassuring by day 5 or 6?

  1. AThe baby sleeps for 8 hours without feeding
  2. BHer breasts never feel full
  3. CThe baby feeds for exactly 5 minutes each side
  4. DAt least 6 wet nappies a day and yellow stools
2.Maternity & obstetric nursingHard

A woman needs an emergency caesarean under general anaesthesia. Why is she given an antacid such as sodium citrate before induction?

  1. ATo lower her blood pressure before surgery
  2. BTo make aspirated stomach contents less acidic
  3. CTo speed up gastric emptying for surgery
  4. DTo prevent nausea after the operation
3.Dosage calculationsMedium
45 kg2 mg/kg/day2× per dayD = ? mg

A patient weighs 45 kg. The prescribed dose is 2 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?

45 kg2 mg/kg/day2× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 5600 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

5600 units10000 units/mL
V = mL
5.IV infusion ratesMedium
320 mLleft? mL/h6 h left

500 mL was ordered over 12 hours. After 6 hours you find that 320 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

500 mL / 12 hafter 6 h: 320 mL
R = mL/h
6.IV infusion ratesHard
750 mL15 gtt/mL32 gtt/mint = ? h

A drip runs at 32 gtt/min through a set of 15 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

32 gtt/min15 gtt/mL750 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: D · At least 6 wet nappies a day and yellow stools

Why this is the answer

Signs of adequate intake include 6 or more wet nappies and several yellow stools a day by day 5 or 6, steady weight gain and a content baby after feeds. Most babies regain birth weight by about 2 weeks.

Answer

D · At least 6 wet nappies a day and yellow stools
2.Maternity & obstetric nursing

Answer: B · To make aspirated stomach contents less acidic

Why this is the answer

Pregnant women are at high risk of aspirating stomach contents under general anaesthesia. Sodium citrate neutralises gastric acid, reducing the severity of lung injury if aspiration happens.

Answer

B · To make aspirated stomach contents less acidic
3.Dosage calculations

Answer: D = 45 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

2·45 = 90 mg

Per dose

D = 90/2 = 45 mg

Answer

D = 45 mg
4.Dosage calculations

Answer: V = 0.56 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 = 5600/10000 = 0.56 mL

On the syringe

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

Answer

V = 0.56 mL
5.IV infusion rates

Answer: R = 53.33 mL/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.

Original rate

500/12 = 41.67 mL/h

New rate

R = 320/6 = 53.33 mL/h

Answer

R = 53.33 mL/h

This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.

6.IV infusion rates

Answer: t = 5.9 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

32·60/15 = 128 mL/h

Time left

t = 750/128 = 5.859 ≈ 5.9 h

Answer

t = 5.9 h

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