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's epidural has just been inserted. Which nursing action is a priority in the next hours?

  1. AKeep her lying flat on her back
  2. BCheck her blood pressure and bladder often
  3. CEncourage her to walk around the room on her own
  4. DRestrict all oral and IV fluids
2.Maternity & obstetric nursingHard

A woman on day 2 after a caesarean suddenly has chest pain, breathlessness, a heart rate of 120/min and an oxygen saturation of 90%. What is the priority?

  1. AGive her a laxative for abdominal pressure
  2. BAsk her to walk to the bathroom
  3. CTell her to rest and recheck in 4 hours
  4. DCall for help, sit her up and give oxygen
3.Dosage calculationsMedium
024681010 mL

A child weighing 26 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

26 kg7.5 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
25k units250 mL? mL/h1200 units/h

An infusion contains 25000 units of a drug in 250 mL. The prescription is 1200 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/250 mL1200 units/h
R = mL/h
5.IV infusion ratesMedium
V = ?60 gtt/mL100 gtt/min6 h

A drip runs at 100 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 6 hours?

100 gtt/min60 gtt/mL6 h
V = mL
6.IV infusion ratesHard
450 mL60 gtt/mL40 gtt/mint = ? h

A drip runs at 40 gtt/min through a set of 60 gtt/mL. There are 450 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

40 gtt/min60 gtt/mL450 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Check her blood pressure and bladder often

Why this is the answer

Epidurals cause sympathetic block, so hypotension is common. They also reduce the urge to void, so the bladder is checked and catheterised if needed. Lateral positions avoid aortocaval compression.

Answer

B · Check her blood pressure and bladder often
2.Maternity & obstetric nursing

Answer: D · Call for help, sit her up and give oxygen

Why this is the answer

Sudden breathlessness, chest pain, tachycardia and hypoxia suggest pulmonary embolism, a leading cause of maternal death. The nurse calls for urgent help, positions her upright, gives oxygen and prepares for investigations and anticoagulation.

Answer

D · Call for help, sit her up and give oxygen
3.Dosage calculations

Answer: V = 7.8 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 = 7.5·26 = 195 mg

Volume

V = 195/25 = 7.8 mL

On the syringe

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

Answer

V = 7.8 mL
4.Dosage calculations

Answer: R = 12 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

25000/250 = 100 units/mL

Pump rate

R = 1200/100 = 12 mL/h

Answer

R = 12 mL/h
5.IV infusion rates

Answer: V = 600 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

100·60/60 = 100 mL/h

Volume

V = 100·6 = 600 mL

Answer

V = 600 mL
6.IV infusion rates

Answer: t = 11.3 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

40·60/60 = 40 mL/h

Time left

t = 450/40 = 11.25 ≈ 11.3 h

Answer

t = 11.3 h

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