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 factors help start the newborn's first breath?

  1. AOnly the cutting of the umbilical cord
  2. BOnly the baby's first cry from hunger
  3. CChemical, thermal, mechanical and sensory cues
  4. DOnly the pressure from the obstetrician's hand
2.Maternity & obstetric nursingHard

A woman at 11 weeks has heavy bleeding, cramping and an open cervical os, and she has passed some tissue. Which type of miscarriage is this?

  1. AIncomplete miscarriage
  2. BThreatened miscarriage
  3. CMissed miscarriage
  4. DComplete miscarriage
3.Dosage calculationsMedium
024681010 mL

A child weighing 13 kg is prescribed 2 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

13 kg2 mg/kg10 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 0.53 mg. The ampoule contains 1000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

0.53 mg1000 mcg/mL
V = mL
5.IV infusion ratesMedium
570 mLleft? mL/h4 h left

1000 mL was ordered over 8 hours. After 4 hours you find that 570 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1000 mL / 8 hafter 4 h: 570 mL
R = mL/h
6.IV infusion ratesHard
25 mg250 mL3 mL/h? mcg/min

An infusion of 25 mg in 250 mL runs at 3 mL/h. How many micrograms per minute D does the patient receive?

25 mg/250 mL3 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: C · Chemical, thermal, mechanical and sensory cues

Why this is the answer

Falling oxygen and rising carbon dioxide (chemical), cooler air (thermal), recoil of the chest after the birth canal (mechanical) and touch, light and sound (sensory) trigger the first breaths.

Answer

C · Chemical, thermal, mechanical and sensory cues
2.Maternity & obstetric nursing

Answer: A · Incomplete miscarriage

Why this is the answer

An open os with some tissue passed and continued bleeding is an incomplete miscarriage. Retained tissue can cause haemorrhage and infection, so it is usually managed medically or surgically.

Answer

A · Incomplete miscarriage
3.Dosage calculations

Answer: V = 2.6 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 = 2·13 = 26 mg

Volume

V = 26/10 = 2.6 mL

On the syringe

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

Answer

V = 2.6 mL
4.Dosage calculations

Answer: V = 0.53 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

0.53 mg = 530 mcg

Volume

V = 530/1000 = 0.53 mL

Answer

V = 0.53 mL
5.IV infusion rates

Answer: R = 142.5 mL/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.

Original rate

1000/8 = 125 mL/h

New rate

R = 570/4 = 142.5 mL/h

Answer

R = 142.5 mL/h

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

6.IV infusion rates

Answer: D = 5 mcg/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

25000 mcg/250 mL = 100 mcg/mL

Dose per hour

3·100 = 300 mcg/h

Dose per minute

D = 300/60 = 5 mcg/min

Answer

D = 5 mcg/min

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