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

A woman has been breastfeeding for 3 weeks. Her baby has gained little weight, feeds briefly and falls asleep at the breast. What is the most appropriate first action?

  1. AAdvise her to stop breastfeeding and use formula only
  2. BReassure her that slow weight gain is normal
  3. CObserve a full feed to assess latch and milk transfer
  4. DTell her to feed only every 6 hours to build hunger
3.Dosage calculationsMedium
90 kg5 mg/kg/day2× per dayD = ? mg

A patient weighs 90 kg. The prescribed dose is 5 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?

90 kg5 mg/kg/day2× per day
D = mg
4.Dosage calculationsHard
25k units1000 mL? mL/h500 units/h

An infusion contains 25000 units of a drug in 1000 mL. The prescription is 500 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/1000 mL500 units/h
R = mL/h
5.IV infusion ratesMedium
60 gtt/mL60 mL/h? gtt/min

An infusion is ordered at 60 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.

60 mL/h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
500 mg250 mL12 mL/h? mg/h

A bag contains 500 mg of a drug in 250 mL and runs at 12 mL/h. How many milligrams per hour D does the patient receive?

500 mg/250 mL12 mL/h
D = mg/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: C · Observe a full feed to assess latch and milk transfer

Why this is the answer

Poor weight gain needs assessment of a full feed, including latch, swallowing and duration, and of the baby's health. Support may include more frequent feeds, breast compression and expressed milk, with medical review.

Answer

C · Observe a full feed to assess latch and milk transfer
3.Dosage calculations

Answer: D = 225 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

5·90 = 450 mg

Per dose

D = 450/2 = 225 mg

Answer

D = 225 mg
4.Dosage calculations

Answer: R = 20 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 = 500/25 = 20 mL/h

Answer

R = 20 mL/h
5.IV infusion rates

Answer: R = 60 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

60/60 = 1 mL/min

Drip rate

R = 1·60 = 60 gtt/min

Answer

R = 60 gtt/min

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

6.IV infusion rates

Answer: D = 24 mg/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.

Concentration

500/250 = 2 mg/mL

Dose rate

D = 2·12 = 24 mg/h

Answer

D = 24 mg/h

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