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 finding on day 4 after a caesarean suggests a wound infection?

  1. ARedness, warmth and discharge
  2. BA closed incision with intact edges
  3. CMild tenderness without redness
  4. DMild numbness of the skin near the scar
2.Maternity & obstetric nursingHard

At 38 weeks, a woman phones to say her baby has been moving much less than usual since yesterday. What is the best advice?

  1. AWait until the next routine appointment next week
  2. BDrink a cold, sugary drink and call only if there is no movement for 3 days
  3. CReduced movement is normal close to term and needs no action
  4. DCome in today for assessment of the fetal heart rate
3.Dosage calculationsMedium
024681010 mL

A child weighing 15 kg is prescribed 4 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

15 kg4 mg/kg20 mg/mL
V = mL
4.Dosage calculationsHard
100 mg/5 mLV = ? mL

A child weighing 12 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?

12 kg10 mg/kg100 mg/5 mL
V = mL
5.IV infusion ratesMedium
500 mL15 gtt/mL12 h? gtt/min

Infuse 500 mL over 12 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 mL12 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
500 mg500 mL12 mL/h? mg/h

A bag contains 500 mg of a drug in 500 mL and runs at 12 mL/h. How many milligrams per hour D does the patient receive?

500 mg/500 mL12 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: A · Redness, warmth and discharge

Why this is the answer

Redness spreading from the incision, warmth, swelling, purulent discharge, gaping edges and fever suggest infection. Numbness near the scar is common and not a sign of infection.

Answer

A · Redness, warmth and discharge
2.Maternity & obstetric nursing

Answer: D · Come in today for assessment of the fetal heart rate

Why this is the answer

Reduced fetal movements can be a warning of fetal compromise. She should be assessed promptly, usually the same day, with a check of the fetal heart rate and further tests as needed. Movements do not normally reduce near term.

Answer

D · Come in today for assessment of the fetal heart rate
3.Dosage calculations

Answer: V = 3 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 = 4·15 = 60 mg

Volume

V = 60/20 = 3 mL

On the syringe

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

Answer

V = 3 mL
4.Dosage calculations

Answer: V = 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

10·12 = 120 mg

Volume

V = (120/100)·5 = 6 mL

Answer

V = 6 mL
5.IV infusion rates

Answer: R = 10 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

12·60 = 720 min

Drip rate

R = 500·15/720 = 10.42 ≈ 10 gtt/min

Answer

R = 10 gtt/min

At the bedside you round to the nearest whole drop: 10 gtt/min.

6.IV infusion rates

Answer: D = 12 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

500/500 = 1 mg/mL

Dose rate

D = 1·12 = 12 mg/h

Answer

D = 12 mg/h

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