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 woman on day 3 after a caesarean has calf pain, swelling and warmth in one leg. What should the nurse do?

  1. AMassage the calf to relieve the cramp
  2. BEncourage her to do vigorous leg exercises
  3. CApply a heating pad and reassess tomorrow
  4. DReport it promptly and avoid massaging the leg
2.Maternity & obstetric nursingHard

A woman on day 2 after a caesarean suddenly has chest pain, breathlessness, a heart rate of 120/min and an oxygen saturation of 90%. What is the priority?

  1. AGive her a laxative for abdominal pressure
  2. BTell her to rest and recheck in 4 hours
  3. CCall for help, sit her up and give oxygen
  4. DAsk her to walk to the bathroom
3.Dosage calculationsMedium
024681010 mL

A child weighing 10 kg is prescribed 20 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

10 kg20 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
V = ?20 gtt/mL35 gtt/min3 h

A drip runs at 35 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 3 hours?

35 gtt/min20 gtt/mL3 h
V = mL
6.IV infusion ratesHard
250 mg50 mL20 mL/h? mg/h

A bag contains 250 mg of a drug in 50 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?

250 mg/50 mL20 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Report it promptly and avoid massaging the leg

Why this is the answer

One-sided calf pain, swelling and warmth suggest deep vein thrombosis, and the postnatal period is a high-risk time. The leg should not be massaged, and the provider should be informed for urgent assessment.

Answer

D · Report it promptly and avoid massaging the leg
2.Maternity & obstetric nursing

Answer: C · Call for help, sit her up and give oxygen

Why this is the answer

Sudden breathlessness, chest pain, tachycardia and hypoxia suggest pulmonary embolism, a leading cause of maternal death. The nurse calls for urgent help, positions her upright, gives oxygen and prepares for investigations and anticoagulation.

Answer

C · Call for help, sit her up and give oxygen
3.Dosage calculations

Answer: V = 8 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 = 20·10 = 200 mg

Volume

V = 200/25 = 8 mL

On the syringe

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

Answer

V = 8 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: V = 315 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

35·60/20 = 105 mL/h

Volume

V = 105·3 = 315 mL

Answer

V = 315 mL
6.IV infusion rates

Answer: D = 100 mg/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.

Concentration

250/50 = 5 mg/mL

Dose rate

D = 5·20 = 100 mg/h

Answer

D = 100 mg/h

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