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

What should parents be taught about the water for a newborn's bath?

  1. AUse very hot water so that germs on the skin are killed
  2. BCheck that it is warm, not hot, before the baby goes in
  3. CAdd adult bubble bath to soften the baby's skin
  4. DLeave the baby briefly if the water is only shallow
2.Maternity & obstetric nursingHard

On a postnatal ward, which finding should be reported immediately?

  1. AMild perineal swelling on day 1
  2. BA fundus 2 cm below the umbilicus on day 2
  3. CLochia rubra on day 2
  4. DThe woman is soaking a large pad within 15 minutes
3.Dosage calculationsMedium
18 kg15 mg/kg/day3× per dayD = ? mg

A patient weighs 18 kg. The prescribed dose is 15 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

18 kg15 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 0.22 mg. The ampoule contains 2000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

0.22 mg2000 mcg/mL
V = mL
5.IV infusion ratesMedium
20 gtt/mL150 mL/h? gtt/min

An infusion is ordered at 150 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.

150 mL/h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
220 mLleft? mL/h2 h left

500 mL was ordered over 6 hours. After 4 hours you find that 220 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

500 mL / 6 hafter 4 h: 220 mL
Δ = %

3Solutions

1.Maternity & obstetric nursing

Answer: B · Check that it is warm, not hot, before the baby goes in

Why this is the answer

Bath water should be comfortably warm, about 37 °C (98.6 °F), checked with a thermometer or the elbow, and the baby is never left alone, even in shallow water. Plain water or a mild baby cleanser is used. Some guidance, such as in the US, advises sponge baths until the cord stump has fallen off.

Answer

B · Check that it is warm, not hot, before the baby goes in
2.Maternity & obstetric nursing

Answer: D · The woman is soaking a large pad within 15 minutes

Why this is the answer

Soaking a pad in 15 minutes is excessive bleeding and needs immediate assessment and escalation. The other findings are normal in the early postnatal period.

Answer

D · The woman is soaking a large pad within 15 minutes
3.Dosage calculations

Answer: D = 90 mg

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.

Total per day

15·18 = 270 mg

Per dose

D = 270/3 = 90 mg

Answer

D = 90 mg
4.Dosage calculations

Answer: V = 0.11 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

0.22 mg = 220 mcg

Volume

V = 220/2000 = 0.11 mL

Answer

V = 0.11 mL
5.IV infusion rates

Answer: R = 50 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.

Millilitres per minute

150/60 = 2.5 mL/min

Drip rate

R = 2.5·20 = 50 gtt/min

Answer

R = 50 gtt/min
6.IV infusion rates

Answer: Δ = 32 %

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

500/6 = 83.33 mL/h

New rate

R = 220/2 = 110 mL/h

Percentage change

Δ = (110 − 83.33)/83.33·100% = 32%

Answer

Δ = 32%

This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.

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