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 1 day after birth has a blood pressure of 150/96 mmHg and a headache. She had normal blood pressures in pregnancy. What should the nurse do?

  1. AEncourage her to walk to lower her blood pressure
  2. BReport it and assess for postpartum pre-eclampsia
  3. CGive paracetamol (acetaminophen) and ignore the blood pressure
  4. DReassure her that this is normal after birth
2.Maternity & obstetric nursingHard

Six hours after birth, a woman has not passed urine. The fundus is boggy and displaced to the right, and bleeding has increased. Why is this a priority?

  1. AIt shows that the epidural is still working well
  2. BUrine retention only matters after a caesarean birth, not after a vaginal one
  3. CA full bladder is a sign of normal recovery
  4. DA full bladder prevents the uterus from contracting and increases bleeding
3.Dosage calculationsMedium
60 kg20 mg/kg/day3× per dayD = ? mg

A patient weighs 60 kg. The prescribed dose is 20 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

60 kg20 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
50%stockwater = ? mL

You must prepare 100 mL of a 0.5% (w/v) solution from a 50% (w/v) stock solution. How much water W must be added to the stock?

C₁ = 50%C₂ = 0.5%V₂ = 100 mL
W = mL
5.IV infusion ratesMedium
1000 mL60 gtt/mL12 h? gtt/min

Infuse 1000 mL over 12 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL12 h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
100 mg50 mL8 mL/h? mg/h

A bag contains 100 mg of a drug in 50 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?

100 mg/50 mL8 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Report it and assess for postpartum pre-eclampsia

Why this is the answer

New hypertension with a headache after birth can be postpartum pre-eclampsia, even with normal readings in pregnancy. The nurse reports it, checks urine protein and symptoms and follows the protocol.

Answer

B · Report it and assess for postpartum pre-eclampsia
2.Maternity & obstetric nursing

Answer: D · A full bladder prevents the uterus from contracting and increases bleeding

Why this is the answer

A distended bladder pushes the uterus up and aside, causing atony and more bleeding. Help her to void, or catheterise per order, then reassess the fundus and the bleeding.

Answer

D · A full bladder prevents the uterus from contracting and increases bleeding
3.Dosage calculations

Answer: D = 400 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

20·60 = 1200 mg

Per dose

D = 1200/3 = 400 mg

Answer

D = 400 mg
4.Dosage calculations

Answer: W = 99 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 = 0.5·100/50 = 1 mL

Water to add

W = 100 − 1 = 99 mL

Answer

W = 99 mL
5.IV infusion rates

Answer: R = 83 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

12·60 = 720 min

Drip rate

R = 1000·60/720 = 83.33 ≈ 83 gtt/min

Answer

R = 83 gtt/min

At the bedside you round to the nearest whole drop: 83 gtt/min.

6.IV infusion rates

Answer: D = 16 mg/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.

Concentration

100/50 = 2 mg/mL

Dose rate

D = 2·8 = 16 mg/h

Answer

D = 16 mg/h

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