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

Which factor most increases a postnatal woman's risk of venous thromboembolism?

  1. ANormal blood loss
  2. BCaesarean birth
  3. CBreastfeeding
  4. DEarly walking after birth
2.Maternity & obstetric nursingHard

The triage nurse receives four phone calls from pregnant women. Who should be told to come in immediately?

  1. AAt 12 weeks with mild nausea in the mornings
  2. BAt 36 weeks with constant pain and a hard uterus
  3. CAt 30 weeks with heartburn after large meals
  4. DAt 25 weeks with mild backache after standing
3.Dosage calculationsMedium
024681010 mL

A child weighing 40 kg is prescribed 2 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

40 kg2 mg/kg20 mg/mL
V = mL
4.Dosage calculationsHard
120 mg/5 mLV = ? mL

A child weighing 16 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 120 mg in 5 mL. What volume V do you give? Round to one decimal place.

16 kg20 mg/kg120 mg/5 mL
V = mL
5.IV infusion ratesMedium
60 gtt/mL120 mL/h? gtt/min

An infusion is ordered at 120 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.

120 mL/h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
400 mL60 gtt/mL40 gtt/mint = ? h

A drip runs at 40 gtt/min through a set of 60 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty?

40 gtt/min60 gtt/mL400 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Caesarean birth

Why this is the answer

Pregnancy and the postpartum period are hypercoagulable. Caesarean birth, immobility, obesity, older age and previous VTE add to the risk. Early walking and, where indicated, prophylaxis reduce it.

Answer

B · Caesarean birth
2.Maternity & obstetric nursing

Answer: B · At 36 weeks with constant pain and a hard uterus

Why this is the answer

Constant pain with a hard, tender uterus suggests placental abruption, which can threaten mother and fetus even with little visible bleeding. The other symptoms are common discomforts.

Answer

B · At 36 weeks with constant pain and a hard uterus
3.Dosage calculations

Answer: V = 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 = 2·40 = 80 mg

Volume

V = 80/20 = 4 mL

On the syringe

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

Answer

V = 4 mL
4.Dosage calculations

Answer: V = 13.3 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

20·16 = 320 mg

Volume

V = (320/120)·5 = 13.33 ≈ 13.3 mL

Answer

V = 13.3 mL
5.IV infusion rates

Answer: R = 120 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

120/60 = 2 mL/min

Drip rate

R = 2·60 = 120 gtt/min

Answer

R = 120 gtt/min

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

6.IV infusion rates

Answer: t = 10 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 = 400/40 = 10 h

Answer

t = 10 h

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