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

How does breast milk jaundice usually differ from early breastfeeding jaundice?

  1. AIt is caused by too little milk intake
  2. BIt always needs the baby to stop breastfeeding permanently
  3. CIt appears in the first 24 hours in a sick baby
  4. DIt appears later, after the first week, in a thriving baby
2.Maternity & obstetric nursingHard

A newborn has excessive frothy saliva and chokes and turns blue with the first feed. What is the priority?

  1. APlace the baby on its back to sleep
  2. BContinue feeding more slowly
  3. CStop feeding and report it urgently
  4. DGive the baby water instead of milk
3.Dosage calculationsMedium
024681010 mL

A child weighing 25 kg is prescribed 10 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

25 kg10 mg/kg50 mg/mL
V = mL
4.Dosage calculationsHard
20%stockV₁ = ? mL

You must prepare 1000 mL of a 1% (w/v) solution from a 20% (w/v) stock solution. What volume of stock V₁ do you need?

C₁ = 20%C₂ = 1%V₂ = 1000 mL
V₁ = mL
5.IV infusion ratesMedium
V = ?20 gtt/mL20 gtt/min4 h

A drip runs at 20 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 4 hours?

20 gtt/min20 gtt/mL4 h
V = mL
6.IV infusion ratesHard
600 mL20 gtt/mL32 gtt/mint = ? h

A drip runs at 32 gtt/min through a set of 20 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

32 gtt/min20 gtt/mL600 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: D · It appears later, after the first week, in a thriving baby

Why this is the answer

Breast milk jaundice begins after the first week and can last several weeks in an otherwise healthy, well-fed baby. It is thought to be caused by substances in milk and rarely needs breastfeeding to stop.

Answer

D · It appears later, after the first week, in a thriving baby
2.Maternity & obstetric nursing

Answer: C · Stop feeding and report it urgently

Why this is the answer

Drooling and choking with feeds suggest oesophageal atresia with or without tracheo-oesophageal fistula. Feeding is stopped, the pouch is suctioned and the baby is kept upright while surgical review is arranged.

Answer

C · Stop feeding and report it urgently
3.Dosage calculations

Answer: V = 5 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 = 10·25 = 250 mg

Volume

V = 250/50 = 5 mL

On the syringe

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

Answer

V = 5 mL
4.Dosage calculations

Answer: V₁ = 50 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Volume of stock

V₁ = 1·1000/20 = 50 mL

Answer

V₁ = 50 mL
5.IV infusion rates

Answer: V = 240 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

20·60/20 = 60 mL/h

Volume

V = 60·4 = 240 mL

Answer

V = 240 mL
6.IV infusion rates

Answer: t = 6.3 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

32·60/20 = 96 mL/h

Time left

t = 600/96 = 6.25 ≈ 6.3 h

Answer

t = 6.3 h

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