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

A woman at 26 weeks asks which symptom she should report straight away. Which one is a danger sign?

  1. ASudden swelling of the face and hands with a headache
  2. BOccasional heartburn after large meals
  3. CMild swelling of the ankles at the end of the day
  4. DIncreased vaginal discharge that is white and odourless
2.Maternity & obstetric nursingHard

After a severe postpartum haemorrhage, a woman cannot breastfeed because her milk does not come in, and she feels very tired. Which condition should be suspected?

  1. AMastitis
  2. BPostpartum thyroiditis
  3. CSheehan syndrome
  4. DBreast engorgement
3.Dosage calculationsMedium
024681010 mL

A child weighing 16 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

16 kg7.5 mg/kg50 mg/mL
V = mL
4.Dosage calculationsHard
40k units250 mL? mL/h1500 units/h

An infusion contains 40000 units of a drug in 250 mL. The prescription is 1500 units per hour. At what rate R do you set the pump, in mL/h?

40000 units/250 mL1500 units/h
R = mL/h
5.IV infusion ratesMedium
1500 mL20 gtt/mL5 h? gtt/min

Infuse 1500 mL over 5 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.

1500 mL5 h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
100 mg250 mL9 mL/h? mcg/min

An infusion of 100 mg in 250 mL runs at 9 mL/h. How many micrograms per minute D does the patient receive?

100 mg/250 mL9 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: A · Sudden swelling of the face and hands with a headache

Why this is the answer

Sudden facial or hand swelling, severe headache, visual changes and upper abdominal pain can signal pre-eclampsia. Mild ankle oedema, white discharge and heartburn are common discomforts.

Answer

A · Sudden swelling of the face and hands with a headache
2.Maternity & obstetric nursing

Answer: C · Sheehan syndrome

Why this is the answer

Sheehan syndrome is pituitary necrosis from severe blood loss and hypotension. Low prolactin causes lactation failure, and other hormone deficiencies cause fatigue, low blood pressure and absent periods.

Answer

C · Sheehan syndrome
3.Dosage calculations

Answer: V = 2.4 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 = 7.5·16 = 120 mg

Volume

V = 120/50 = 2.4 mL

On the syringe

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

Answer

V = 2.4 mL
4.Dosage calculations

Answer: R = 9.375 mL/h

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.

Concentration

40000/250 = 160 units/mL

Pump rate

R = 1500/160 = 9.375 mL/h

Answer

R = 9.375 mL/h
5.IV infusion rates

Answer: R = 100 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 = 1500·20/300 = 100 gtt/min

Answer

R = 100 gtt/min
6.IV infusion rates

Answer: D = 60 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

100000 mcg/250 mL = 400 mcg/mL

Dose per hour

9·400 = 3600 mcg/h

Dose per minute

D = 3600/60 = 60 mcg/min

Answer

D = 60 mcg/min

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