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 postpartum woman who is not immune to rubella receives the vaccine before discharge. What advice is essential?

  1. AStop breastfeeding for 4 weeks
  2. BAvoid becoming pregnant for at least 4 weeks
  3. CHave the vaccine repeated in 6 months
  4. DKeep away from her newborn for 2 days
2.Maternity & obstetric nursingHard

A breastfeeding mother asks whether she can have a progestin-only implant before discharge. Which reply is best?

  1. AProgestin-only methods are compatible with breastfeeding
  2. BImplants contain oestrogen, which is safe in breastfeeding
  3. CShe should wait until she stops breastfeeding before using any method
  4. DAny hormonal contraception will stop her milk supply
3.Dosage calculationsMedium
30 kg30 mg/kg/day3× per dayD = ? mg

A patient weighs 30 kg. The prescribed dose is 30 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

30 kg30 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 4050 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

4050 units5000 units/mL
V = mL
5.IV infusion ratesMedium
250 mL20 gtt/mL5 h? gtt/min

Infuse 250 mL over 5 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL5 h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
450 mL60 gtt/mL50 gtt/mint = ? h

A drip runs at 50 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?

50 gtt/min60 gtt/mL450 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Avoid becoming pregnant for at least 4 weeks

Why this is the answer

The rubella vaccine contains a live attenuated virus, so pregnancy should be avoided for at least 4 weeks after vaccination. It is compatible with breastfeeding.

Answer

B · Avoid becoming pregnant for at least 4 weeks
2.Maternity & obstetric nursing

Answer: A · Progestin-only methods are compatible with breastfeeding

Why this is the answer

Progestin-only methods such as implants, injections and pills do not have a clinically important effect on milk supply. Oestrogen-containing methods are usually avoided in the first weeks.

Answer

A · Progestin-only methods are compatible with breastfeeding
3.Dosage calculations

Answer: D = 300 mg

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.

Total per day

30·30 = 900 mg

Per dose

D = 900/3 = 300 mg

Answer

D = 300 mg
4.Dosage calculations

Answer: V = 0.81 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 = 4050/5000 = 0.81 mL

On the syringe

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

Answer

V = 0.81 mL
5.IV infusion rates

Answer: R = 17 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

5·60 = 300 min

Drip rate

R = 250·20/300 = 16.67 ≈ 17 gtt/min

Answer

R = 17 gtt/min

At the bedside you round to the nearest whole drop: 17 gtt/min.

6.IV infusion rates

Answer: t = 9 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

50·60/60 = 50 mL/h

Time left

t = 450/50 = 9 h

Answer

t = 9 h

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