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

Why are afterpains often stronger in multiparous women?

  1. ATheir uterus contracts and relaxes more irregularly
  2. BTheir uterus is always infected
  3. CThey produce no oxytocin after birth
  4. DThey have a smaller uterus than first-time mothers
2.Maternity & obstetric nursingHard

A woman has a postpartum haemorrhage. Which nursing action should be done first while help is coming?

  1. AGive the baby a bath to free the mother's time
  2. BWeigh the used pads and record the total
  3. CMassage the fundus and look for the source
  4. DDocument the estimated blood loss in the notes
3.Dosage calculationsMedium
25 kg7.5 mg/kgD = ? mg

A patient weighs 25 kg and is prescribed 7.5 mg/kg as a single dose. Find the dose D in mg.

25 kg7.5 mg/kg
D = mg
4.Dosage calculationsHard
125 mg/5 mLV = ? mL

A child weighing 14 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?

14 kg10 mg/kg125 mg/5 mL
V = mL
5.IV infusion ratesMedium
1000 mL10 gtt/mL4 h? gtt/min

Infuse 1000 mL over 4 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL4 h10 gtt/mL
R = gtt/min
6.IV infusion ratesHard
1000 mg50 mL5 mL/h? mg/h

A bag contains 1000 mg of a drug in 50 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?

1000 mg/50 mL5 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: A · Their uterus contracts and relaxes more irregularly

Why this is the answer

In multiparas, and after overdistension such as twins, the uterus relaxes and contracts intermittently, causing stronger afterpains. Breastfeeding increases them through oxytocin.

Answer

A · Their uterus contracts and relaxes more irregularly
2.Maternity & obstetric nursing

Answer: C · Massage the fundus and look for the source

Why this is the answer

The first priority is to stop the bleeding: massage a boggy fundus, check for tears, empty the bladder and give uterotonics per protocol. Weighing pads gives a more accurate blood loss but comes after life-saving actions.

Answer

C · Massage the fundus and look for the source
3.Dosage calculations

Answer: D = 187.5 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

7.5·25 = 187.5 mg

Answer

D = 187.5 mg
4.Dosage calculations

Answer: V = 5.6 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

10·14 = 140 mg

Volume

V = (140/125)·5 = 5.6 mL

Answer

V = 5.6 mL
5.IV infusion rates

Answer: R = 42 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 = 1000·10/240 = 41.67 ≈ 42 gtt/min

Answer

R = 42 gtt/min

At the bedside you round to the nearest whole drop: 42 gtt/min.

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

1000/50 = 20 mg/mL

Dose rate

D = 20·5 = 100 mg/h

Answer

D = 100 mg/h

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