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

A woman has just been diagnosed with gestational diabetes at 26 weeks. What is the usual first step in management?

  1. ANo follow-up is needed until after birth
  2. BStart insulin or an oral sulfonylurea straight away for every woman, whatever her blood glucose readings show
  3. CStop eating all carbohydrates
  4. DNutrition advice, physical activity and blood glucose monitoring, with medication if targets are not met
3.Dosage calculationsMedium
024681010 mL

A child weighing 33 kg is prescribed 5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

33 kg5 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
20k units1000 mL? mL/h800 units/h

An infusion contains 20000 units of a drug in 1000 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?

20000 units/1000 mL800 units/h
R = mL/h
5.IV infusion ratesMedium
500 mL15 gtt/mL4 h? gtt/min

Infuse 500 mL over 4 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL4 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
600 mL60 gtt/mL28 gtt/mint = ? h

A drip runs at 28 gtt/min through a set of 60 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

28 gtt/min60 gtt/mL600 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: A · 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

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

Answer: D · Nutrition advice, physical activity and blood glucose monitoring, with medication if targets are not met

Why this is the answer

First-line management is medical nutrition therapy, activity and self-monitoring of glucose. If targets are not met, medication such as insulin is added. Glucose is tested again after birth because the risk of type 2 diabetes is raised.

Answer

D · Nutrition advice, physical activity and blood glucose monitoring, with medication if targets are not met
3.Dosage calculations

Answer: V = 6.6 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 = 5·33 = 165 mg

Volume

V = 165/25 = 6.6 mL

On the syringe

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

Answer

V = 6.6 mL
4.Dosage calculations

Answer: R = 40 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

20000/1000 = 20 units/mL

Pump rate

R = 800/20 = 40 mL/h

Answer

R = 40 mL/h
5.IV infusion rates

Answer: R = 31 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

4·60 = 240 min

Drip rate

R = 500·15/240 = 31.25 ≈ 31 gtt/min

Answer

R = 31 gtt/min

At the bedside you round to the nearest whole drop: 31 gtt/min.

6.IV infusion rates

Answer: t = 21.4 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

28·60/60 = 28 mL/h

Time left

t = 600/28 = 21.43 ≈ 21.4 h

Answer

t = 21.4 h

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