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 woman at 18 weeks asks about safe exercise. Which advice is correct?

  1. AExercise should be stopped completely during pregnancy
  2. BContact sports and scuba diving are safe if she did them before
  3. CExercise lying flat on her back is best after 20 weeks
  4. DModerate exercise like walking or swimming is encouraged
2.Maternity & obstetric nursingHard

A woman has hyperthyroidism in pregnancy. Which finding in the fetus should be monitored?

  1. AFetal macrosomia
  2. BFetal tachycardia and poor growth
  3. CA fetal heart rate below 100 bpm
  4. DFetal polycythaemia only
3.Dosage calculationsMedium
024681010 mL

A child weighing 28 kg is prescribed 15 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

28 kg15 mg/kg50 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 790 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

790 units1000 units/mL
V = mL
5.IV infusion ratesMedium
500 mL20 gtt/mL8 h? gtt/min

Infuse 500 mL over 8 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL8 h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
300 mL15 gtt/mL20 gtt/mint = ? h

A drip runs at 20 gtt/min through a set of 15 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

20 gtt/min15 gtt/mL300 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Moderate exercise like walking or swimming is encouraged

Why this is the answer

Moderate exercise is safe and beneficial for most pregnant women. Contact sports, activities with a high fall risk and scuba diving are avoided, as is lying flat on the back for long periods later in pregnancy.

Answer

D · Moderate exercise like walking or swimming is encouraged
2.Maternity & obstetric nursing

Answer: B · Fetal tachycardia and poor growth

Why this is the answer

In Graves' disease, maternal antibodies can cross the placenta and cause fetal hyperthyroidism, with tachycardia, goitre and growth restriction. Antithyroid drugs also cross the placenta, so the fetus is monitored.

Answer

B · Fetal tachycardia and poor growth
3.Dosage calculations

Answer: V = 8.4 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 = 15·28 = 420 mg

Volume

V = 420/50 = 8.4 mL

On the syringe

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

Answer

V = 8.4 mL
4.Dosage calculations

Answer: V = 0.79 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 = 790/1000 = 0.79 mL

On the syringe

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

Answer

V = 0.79 mL
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

8·60 = 480 min

Drip rate

R = 500·20/480 = 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

20·60/15 = 80 mL/h

Time left

t = 300/80 = 3.75 ≈ 3.8 h

Answer

t = 3.8 h

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