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 feature best distinguishes true labour from false labour?

  1. ADiscomfort that eases with a warm bath and rest
  2. BContractions that are felt only in the lower abdomen
  3. CProgressive dilation and effacement of the cervix
  4. DContractions that stop when the woman walks around
2.Maternity & obstetric nursingHard

A woman has a painful, red breast with a fluctuant swelling that has not improved after antibiotics. What should be suspected?

  1. AAn allergic reaction to the antibiotic
  2. BNormal engorgement
  3. CA breast abscess needing drainage
  4. DA blocked duct needing only massage
3.Dosage calculationsMedium
2%w/vV = ? mL

A dose of 80 mg is needed from a 2% (w/v) solution. What volume V contains this dose?

80 mg2% w/v
V = mL
4.Dosage calculationsHard
200 mg/5 mLV = ? mL

A child weighing 12 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 200 mg in 5 mL. What volume V do you give?

12 kg15 mg/kg200 mg/5 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
400 mL60 gtt/mL30 gtt/mint = ? h

A drip runs at 30 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? Round to one decimal place.

30 gtt/min60 gtt/mL400 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: C · Progressive dilation and effacement of the cervix

Why this is the answer

True labour causes progressive cervical change. Its contractions become regular, stronger and closer and do not stop with rest or walking. False labour contractions are irregular and ease with rest or position change.

Answer

C · Progressive dilation and effacement of the cervix
2.Maternity & obstetric nursing

Answer: C · A breast abscess needing drainage

Why this is the answer

A fluctuant, persistent painful mass despite antibiotics suggests a breast abscess. It needs ultrasound and drainage. Breastfeeding from the other breast can usually continue.

Answer

C · A breast abscess needing drainage
3.Dosage calculations

Answer: V = 4 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Concentration

2% = 20 mg/mL

Volume

V = 80/20 = 4 mL

Answer

V = 4 mL
4.Dosage calculations

Answer: V = 4.5 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

15·12 = 180 mg

Volume

V = (180/200)·5 = 4.5 mL

Answer

V = 4.5 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 = 13.3 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

30·60/60 = 30 mL/h

Time left

t = 400/30 = 13.33 ≈ 13.3 h

Answer

t = 13.3 h

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