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

After a circumcision, which finding should be reported?

  1. AFussiness at the first nappy change
  2. BA yellowish film over the glans on day 2
  3. CActive bleeding that soaks a nappy
  4. DMild swelling of the glans
2.Maternity & obstetric nursingHard

A term newborn has rapid breathing at 2 hours after a caesarean without labour. Saturation is normal, there is no fever and the chest X-ray shows fluid in the fissures. What is the most likely diagnosis?

  1. ARespiratory distress syndrome of prematurity
  2. BTransient tachypnoea of the newborn
  3. CNeonatal pneumonia with sepsis
  4. DMeconium aspiration syndrome
3.Dosage calculationsMedium
25 kg25 mg/kgD = ? mg

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

25 kg25 mg/kg
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 2640 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

2640 mcg4 mg/mL
V = mL
5.IV infusion ratesMedium
250 mL15 gtt/mL2 h? gtt/min

Infuse 250 mL over 2 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL2 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
1000 mg100 mL15 mL/h? mg/h

A bag contains 1000 mg of a drug in 100 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?

1000 mg/100 mL15 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: C · Active bleeding that soaks a nappy

Why this is the answer

A yellow film is normal granulation tissue, and mild swelling and fussiness are common. Persistent bleeding, signs of infection or failure to pass urine should be reported.

Answer

C · Active bleeding that soaks a nappy
2.Maternity & obstetric nursing

Answer: B · Transient tachypnoea of the newborn

Why this is the answer

Transient tachypnoea is common after caesarean birth without labour. Supportive care is usually enough, but infection must be considered if the baby becomes unwell or fails to improve.

Answer

B · Transient tachypnoea of the newborn
3.Dosage calculations

Answer: D = 625 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

25·25 = 625 mg

Answer

D = 625 mg
4.Dosage calculations

Answer: V = 0.66 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.

Same units

4 mg/mL = 4000 mcg/mL

Volume

V = 2640/4000 = 0.66 mL

Answer

V = 0.66 mL
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

2·60 = 120 min

Drip rate

R = 250·15/120 = 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: D = 150 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

1000/100 = 10 mg/mL

Dose rate

D = 10·15 = 150 mg/h

Answer

D = 150 mg/h

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