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 statement about the lactational amenorrhoea method (LAM) is correct?

  1. AIt needs full breastfeeding, no periods and a baby under 6 months
  2. BIt becomes more reliable after the periods return
  3. CIt works for as long as the mother breastfeeds at all
  4. DIt is reliable even when the baby is formula-fed at night
2.Maternity & obstetric nursingHard

Which postpartum woman should the nurse assess first?

  1. ADay 3: full, firm, tender breasts
  2. BDay 2: cramping during breastfeeding
  3. COne hour after birth: heart rate 118/min and a boggy fundus
  4. DDay 1: moderate lochia rubra with a few clots smaller than a coin
3.Dosage calculationsMedium
024681010 mL

A child weighing 36 kg is prescribed 10 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?

36 kg10 mg/kg40 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 660 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

660 units1000 units/mL
V = mL
5.IV infusion ratesMedium
250 mL15 gtt/mL5 h? gtt/min

Infuse 250 mL over 5 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 mL5 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
100 mg500 mL8 mL/h? mg/h

A bag contains 100 mg of a drug in 500 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?

100 mg/500 mL8 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: A · It needs full breastfeeding, no periods and a baby under 6 months

Why this is the answer

LAM is effective only if the mother is fully or nearly fully breastfeeding day and night, her periods have not returned and the baby is under 6 months. Ovulation can occur before the first period.

Answer

A · It needs full breastfeeding, no periods and a baby under 6 months
2.Maternity & obstetric nursing

Answer: C · One hour after birth: heart rate 118/min and a boggy fundus

Why this is the answer

A boggy uterus with tachycardia in the first hour suggests haemorrhage and needs immediate assessment. Small clots on day 1, afterpains and engorgement on day 3 are expected.

Answer

C · One hour after birth: heart rate 118/min and a boggy fundus
3.Dosage calculations

Answer: V = 9 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 = 10·36 = 360 mg

Volume

V = 360/40 = 9 mL

On the syringe

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

Answer

V = 9 mL
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.

Volume

V = 660/1000 = 0.66 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.66 mL
5.IV infusion rates

Answer: R = 13 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

5·60 = 300 min

Drip rate

R = 250·15/300 = 12.5 ≈ 13 gtt/min

Answer

R = 13 gtt/min

At the bedside you round to the nearest whole drop: 13 gtt/min.

6.IV infusion rates

Answer: D = 1.6 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

100/500 = 0.2 mg/mL

Dose rate

D = 0.2·8 = 1.6 mg/h

Answer

D = 1.6 mg/h

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