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

A woman 1 day after a caesarean asks how to hold her baby for breastfeeding without pressure on her wound. Which position is best?

  1. AThe cradle hold with the baby across the incision
  2. BLying flat on her back with the baby on her abdomen
  3. CStanding up while breastfeeding
  4. DThe football (rugby) hold or side-lying
3.Dosage calculationsMedium
024681010 mL

A child weighing 40 kg is prescribed 2 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

40 kg2 mg/kg50 mg/mL
V = mL
4.Dosage calculationsHard
125 mg/5 mLV = ? mL

A child weighing 24 kg is prescribed 5 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?

24 kg5 mg/kg125 mg/5 mL
V = mL
5.IV infusion ratesMedium
60 gtt/mL125 mL/h? gtt/min

An infusion is ordered at 125 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.

125 mL/h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
1000 mg250 mL20 gtt/mL300 mg/h? gtt/min

1000 mg of a drug is diluted in 250 mL and given by gravity through a set of 20 gtt/mL. The order is 300 mg per hour. Find the drip rate R in drops per minute.

1000 mg/250 mL300 mg/h20 gtt/mL
R = gtt/min

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: D · The football (rugby) hold or side-lying

Why this is the answer

The football hold places the baby along her side, and side-lying avoids any pressure on the abdomen. A pillow over the wound also helps.

Answer

D · The football (rugby) hold or side-lying
3.Dosage calculations

Answer: V = 1.6 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 = 2·40 = 80 mg

Volume

V = 80/50 = 1.6 mL

On the syringe

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

Answer

V = 1.6 mL
4.Dosage calculations

Answer: V = 4.8 mL

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.

Dose from weight

5·24 = 120 mg

Volume

V = (120/125)·5 = 4.8 mL

Answer

V = 4.8 mL
5.IV infusion rates

Answer: R = 125 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

125/60 = 2.083 mL/min

Drip rate

R = 2.083·60 = 125 gtt/min

Answer

R = 125 gtt/min

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

6.IV infusion rates

Answer: R = 25 gtt/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

1000/250 = 4 mg/mL

Volume per hour

300/4 = 75 mL/h

Drip rate

R = 75·20/60 = 25 gtt/min

Answer

R = 25 gtt/min

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