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 finding in a term newborn's first hours is normal?

  1. AShort breathing pauses with no colour change
  2. BPauses in breathing of 30 seconds with bradycardia
  3. CCentral cyanosis of the lips and tongue
  4. DA respiratory rate of 80 at rest with retractions
2.Maternity & obstetric nursingHard

Which finding in a woman 2 hours after birth requires the most urgent follow-up?

  1. ATemperature 37.6 °C and shivering
  2. BFundus firm and 1 cm below the umbilicus
  3. CHeart rate 124/min with cool, clammy skin
  4. DModerate lochia rubra with a few small clots
3.Dosage calculationsMedium
024681010 mL

A child weighing 36 kg is prescribed 5 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

36 kg5 mg/kg20 mg/mL
V = mL
4.Dosage calculationsHard
25k units1000 mL? mL/h1250 units/h

An infusion contains 25000 units of a drug in 1000 mL. The prescription is 1250 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/1000 mL1250 units/h
R = mL/h
5.IV infusion ratesMedium
500 mL15 gtt/mL6 h? gtt/min

Infuse 500 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.

500 mL6 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
750 mL15 gtt/mL50 gtt/mint = ? h

A drip runs at 50 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.

50 gtt/min15 gtt/mL750 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: A · Short breathing pauses with no colour change

Why this is the answer

Newborns breathe irregularly, with short pauses of a few seconds and no change in colour or heart rate. Apnoea of 20 seconds or more, or any pause with cyanosis or bradycardia, is abnormal.

Answer

A · Short breathing pauses with no colour change
2.Maternity & obstetric nursing

Answer: C · Heart rate 124/min with cool, clammy skin

Why this is the answer

Tachycardia with cool, clammy skin is an early sign of hypovolaemia from hidden or ongoing bleeding. A firm fundus and moderate lochia are normal, and mild temperature rise and shivering are common in the first 24 hours.

Answer

C · Heart rate 124/min with cool, clammy skin
3.Dosage calculations

Answer: V = 9 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 = 5·36 = 180 mg

Volume

V = 180/20 = 9 mL

On the syringe

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

Answer

V = 9 mL
4.Dosage calculations

Answer: R = 50 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 = 1250/25 = 50 mL/h

Answer

R = 50 mL/h
5.IV infusion rates

Answer: R = 21 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 = 500·15/360 = 20.83 ≈ 21 gtt/min

Answer

R = 21 gtt/min

At the bedside you round to the nearest whole drop: 21 gtt/min.

6.IV infusion rates

Answer: t = 3.8 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 = 750/200 = 3.75 ≈ 3.8 h

Answer

t = 3.8 h

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