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

When performing the first Leopold manoeuvre, what is the nurse trying to identify?

  1. AWhether the head has entered the pelvis
  2. BWhich fetal part lies in the fundus
  3. CThe amount of amniotic fluid
  4. DWhich side the fetal back lies on
2.Maternity & obstetric nursingHard

A woman 5 hours after birth had a large blood loss and now has a heart rate of 128/min, blood pressure of 88/50 mmHg and cold hands. Which action is most important?

  1. AEncourage her to breastfeed to contract the uterus
  2. BCall for urgent help and start fluid resuscitation
  3. CGive her a hot drink and recheck in an hour
  4. DAsk her to walk to improve circulation
3.Dosage calculationsMedium
40 kgBSA = 1.21 m²175 mg/m²D = ? mg

A patient weighing 40 kg has a body surface area of 1.21 m². The prescription is 175 mg/m². Find the dose D in mg.

40 kgBSA = 1.21 m²175 mg/m²
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 4100 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

4100 units5000 units/mL
V = mL
5.IV infusion ratesMedium
V = ?15 gtt/mL50 gtt/min12 h

A drip runs at 50 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 12 hours?

50 gtt/min15 gtt/mL12 h
V = mL
6.IV infusion ratesHard
400 mL20 gtt/mL28 gtt/mint = ? h

A drip runs at 28 gtt/min through a set of 20 gtt/mL. There are 400 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

28 gtt/min20 gtt/mL400 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Which fetal part lies in the fundus

Why this is the answer

The first Leopold manoeuvre palpates the fundus: a firm round head or a softer, irregular breech. The second finds the back and limbs, the third the presenting part and the fourth the degree of head flexion and descent.

Answer

B · Which fetal part lies in the fundus
2.Maternity & obstetric nursing

Answer: B · Call for urgent help and start fluid resuscitation

Why this is the answer

Tachycardia, hypotension and cool peripheries indicate hypovolaemic shock. Help is called, IV access secured, fluids and blood given as prescribed, and the cause of bleeding treated.

Answer

B · Call for urgent help and start fluid resuscitation
3.Dosage calculations

Answer: D = 211.8 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Dose

D = 175·1.21 = 211.8 mg

Answer

D = 211.8 mg
4.Dosage calculations

Answer: V = 0.82 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 = 4100/5000 = 0.82 mL

On the syringe

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

Answer

V = 0.82 mL
5.IV infusion rates

Answer: V = 2400 mL

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.

Rate in mL/h

50·60/15 = 200 mL/h

Volume

V = 200·12 = 2400 mL

Answer

V = 2400 mL
6.IV infusion rates

Answer: t = 4.8 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.

Rate in mL/h

28·60/20 = 84 mL/h

Time left

t = 400/84 = 4.762 ≈ 4.8 h

Answer

t = 4.8 h

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