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

When performing the first Leopold manoeuvre, what is the nurse trying to identify?

  1. AWhich side the fetal back lies on
  2. BThe amount of amniotic fluid
  3. CWhich fetal part lies in the fundus
  4. DWhether the head has entered the pelvis
2.Maternity & obstetric nursingHard

A preterm baby born at 28 weeks is at risk of intraventricular haemorrhage. Which nursing measure reduces this risk?

  1. AFrequent handling and stimulation to keep the baby alert
  2. BMinimal handling with the head in midline
  3. CKeeping the head of the cot lower than the feet
  4. DRapid fluid boluses to support blood pressure
3.Dosage calculationsMedium
024681010 mL

A child weighing 6 kg is prescribed 20 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?

6 kg20 mg/kg40 mg/mL
V = mL
4.Dosage calculationsHard
25k units500 mL? mL/h2000 units/h

An infusion contains 25000 units of a drug in 500 mL. The prescription is 2000 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/500 mL2000 units/h
R = mL/h
5.IV infusion ratesMedium
V = ?60 gtt/mL50 gtt/min6 h

A drip runs at 50 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 6 hours?

50 gtt/min60 gtt/mL6 h
V = mL
6.IV infusion ratesHard
240 mLleft? mL/h4 h left

500 mL was ordered over 10 hours. After 6 hours you find that 240 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

500 mL / 10 hafter 6 h: 240 mL
Δ = %

3Solutions

1.Maternity & obstetric nursing

Answer: C · Which fetal part lies in the fundus

Why this is the answer

The first Leopold manoeuvre palpates the fundus: a firm round head or a softer, irregular breech. The second finds the back and limbs, the third the presenting part and the fourth the degree of head flexion and descent.

Answer

C · Which fetal part lies in the fundus
2.Maternity & obstetric nursing

Answer: B · Minimal handling with the head in midline

Why this is the answer

Preterm babies have fragile germinal matrix vessels. Minimal handling, midline head position, slight elevation of the head and avoiding rapid fluid or pressure changes help prevent bleeding into the ventricles.

Answer

B · Minimal handling with the head in midline
3.Dosage calculations

Answer: V = 3 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 = 20·6 = 120 mg

Volume

V = 120/40 = 3 mL

On the syringe

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

Answer

V = 3 mL
4.Dosage calculations

Answer: R = 40 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

25000/500 = 50 units/mL

Pump rate

R = 2000/50 = 40 mL/h

Answer

R = 40 mL/h
5.IV infusion rates

Answer: V = 300 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

50·60/60 = 50 mL/h

Volume

V = 50·6 = 300 mL

Answer

V = 300 mL
6.IV infusion rates

Answer: Δ = 20 %

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

500/10 = 50 mL/h

New rate

R = 240/4 = 60 mL/h

Percentage change

Δ = (60 − 50)/50·100% = 20%

Answer

Δ = 20%

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

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