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 findings are typical of placental abruption?

  1. APainless bright red bleeding with a soft, relaxed, non-tender uterus
  2. BLeaking clear fluid without contractions
  3. CAbdominal pain, a firm or rigid uterus and dark red bleeding
  4. DItching of the palms and soles
2.Maternity & obstetric nursingHard

A baby was stillborn at 38 weeks. Which nursing action is most appropriate?

  1. ARemove the baby quickly so the parents are not upset
  2. BOffer the parents time to see and hold their baby
  3. CAvoid using the baby's name to prevent more grief
  4. DTell the parents they can try for another baby soon
3.Dosage calculationsMedium
30 kg15 mg/kgD = ? mg

A patient weighs 30 kg and is prescribed 15 mg/kg as a single dose. Find the dose D in mg.

30 kg15 mg/kg
D = mg
4.Dosage calculationsHard
40 mg/1 mLV = ? mL

A child weighing 28 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?

28 kg20 mg/kg40 mg/1 mL
V = mL
5.IV infusion ratesMedium
V = ?60 gtt/mL60 gtt/min8 h

A drip runs at 60 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 8 hours?

60 gtt/min60 gtt/mL8 h
V = mL
6.IV infusion ratesHard
100 mg250 mL15 mL/h? mcg/min

An infusion of 100 mg in 250 mL runs at 15 mL/h. How many micrograms per minute D does the patient receive?

100 mg/250 mL15 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: C · Abdominal pain, a firm or rigid uterus and dark red bleeding

Why this is the answer

Abruption causes pain, uterine tenderness and rigidity, and dark bleeding. The bleeding can be hidden behind the placenta, so blood loss may be much larger than what is visible.

Answer

C · Abdominal pain, a firm or rigid uterus and dark red bleeding
2.Maternity & obstetric nursing

Answer: B · Offer the parents time to see and hold their baby

Why this is the answer

Parents should be offered time with their baby, to name, hold and dress the baby if they wish, and keepsakes such as photographs, footprints or locks of hair. Their choices should be respected without pressure.

Answer

B · Offer the parents time to see and hold their baby
3.Dosage calculations

Answer: D = 450 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.

Dose

15·30 = 450 mg

Answer

D = 450 mg
4.Dosage calculations

Answer: V = 14 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

20·28 = 560 mg

Volume

V = (560/40)·1 = 14 mL

Answer

V = 14 mL
5.IV infusion rates

Answer: V = 480 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

60·60/60 = 60 mL/h

Volume

V = 60·8 = 480 mL

Answer

V = 480 mL
6.IV infusion rates

Answer: D = 100 mcg/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

100000 mcg/250 mL = 400 mcg/mL

Dose per hour

15·400 = 6000 mcg/h

Dose per minute

D = 6000/60 = 100 mcg/min

Answer

D = 100 mcg/min

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