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

On day 1 after birth, a woman's white cell count is mildly raised and she has no symptoms. How should this be interpreted?

  1. AIt shows she is dehydrated
  2. BIt means she has leukaemia
  3. CIt can be normal soon after birth
  4. DIt proves she has an infection
2.Maternity & obstetric nursingHard

A woman who had a placenta praevia and two previous caesareans is scheduled for a caesarean. The team plans for possible hysterectomy and blood products. Why?

  1. AShe is at high risk of placenta accreta spectrum
  2. BShe is at high risk of a post-term birth
  3. CShe is at high risk of pre-eclampsia only
  4. DShe is at high risk of gestational diabetes
3.Dosage calculationsMedium
60 kg10 mg/kgD = ? mg

A patient weighs 60 kg and is prescribed 10 mg/kg as a single dose. Find the dose D in mg.

60 kg10 mg/kg
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1400 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1400 units10000 units/mL
V = mL
5.IV infusion ratesMedium
1000 mL20 gtt/mL12 h? gtt/min

Infuse 1000 mL over 12 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL12 h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
200 mg100 mL60 gtt/mL200 mg/h? gtt/min

200 mg of a drug is diluted in 100 mL and given by gravity through a set of 60 gtt/mL. The order is 200 mg per hour. Find the drip rate R in drops per minute.

200 mg/100 mL200 mg/h60 gtt/mL
R = gtt/min

3Solutions

1.Maternity & obstetric nursing

Answer: C · It can be normal soon after birth

Why this is the answer

Leucocytosis is common in labour and the early postnatal period. It must be interpreted with clinical signs such as fever, pain and lochia changes rather than on its own.

Answer

C · It can be normal soon after birth
2.Maternity & obstetric nursing

Answer: A · She is at high risk of placenta accreta spectrum

Why this is the answer

A placenta praevia overlying a previous caesarean scar greatly raises the risk of an abnormally adherent placenta. This can cause massive haemorrhage, so delivery is planned in a unit with blood bank support.

Answer

A · She is at high risk of placenta accreta spectrum
3.Dosage calculations

Answer: D = 600 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.

Dose

10·60 = 600 mg

Answer

D = 600 mg
4.Dosage calculations

Answer: V = 0.14 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 = 1400/10000 = 0.14 mL

On the syringe

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

Answer

V = 0.14 mL
5.IV infusion rates

Answer: R = 28 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 = 1000·20/720 = 27.78 ≈ 28 gtt/min

Answer

R = 28 gtt/min

At the bedside you round to the nearest whole drop: 28 gtt/min.

6.IV infusion rates

Answer: R = 100 gtt/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

200/100 = 2 mg/mL

Volume per hour

200/2 = 100 mL/h

Drip rate

R = 100·60/60 = 100 gtt/min

Answer

R = 100 gtt/min

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