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

Which is a common sign of iron deficiency anaemia in pregnancy?

  1. AIncreased appetite and frequent urination
  2. BWeight gain and ankle swelling
  3. CTiredness, pallor and breathlessness
  4. DHigh blood pressure and headache
2.Maternity & obstetric nursingHard

A woman who had a stillbirth asks the nurse why it happened. What is the most appropriate response?

  1. ATell her it was probably something she ate
  2. BAcknowledge her grief; tests may find a cause
  3. CTell her she should not have exercised
  4. DChange the subject to avoid upsetting her
3.Dosage calculationsMedium
024681010 mL

A child weighing 38 kg is prescribed 5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

38 kg5 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
50k units1000 mL? mL/h1250 units/h

An infusion contains 50000 units of a drug in 1000 mL. The prescription is 1250 units per hour. At what rate R do you set the pump, in mL/h?

50000 units/1000 mL1250 units/h
R = mL/h
5.IV infusion ratesMedium
500 mL10 gtt/mL10 h? gtt/min

Infuse 500 mL over 10 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL10 h10 gtt/mL
R = gtt/min
6.IV infusion ratesHard
100 mg250 mL25 mL/h? mg/h

A bag contains 100 mg of a drug in 250 mL and runs at 25 mL/h. How many milligrams per hour D does the patient receive?

100 mg/250 mL25 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: C · Tiredness, pallor and breathlessness

Why this is the answer

Iron deficiency causes fatigue, pallor, breathlessness, palpitations and sometimes pica. A full blood count and ferritin confirm the diagnosis.

Answer

C · Tiredness, pallor and breathlessness
2.Maternity & obstetric nursing

Answer: B · Acknowledge her grief; tests may find a cause

Why this is the answer

The nurse acknowledges her grief, avoids blame and explains that investigations such as a post-mortem and placental examination may help find a cause, although often none is found.

Answer

B · Acknowledge her grief; tests may find a cause
3.Dosage calculations

Answer: V = 7.6 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 = 5·38 = 190 mg

Volume

V = 190/25 = 7.6 mL

On the syringe

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

Answer

V = 7.6 mL
4.Dosage calculations

Answer: R = 25 mL/h

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.

Concentration

50000/1000 = 50 units/mL

Pump rate

R = 1250/50 = 25 mL/h

Answer

R = 25 mL/h
5.IV infusion rates

Answer: R = 8 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

10·60 = 600 min

Drip rate

R = 500·10/600 = 8.333 ≈ 8 gtt/min

Answer

R = 8 gtt/min

At the bedside you round to the nearest whole drop: 8 gtt/min.

6.IV infusion rates

Answer: D = 10 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

100/250 = 0.4 mg/mL

Dose rate

D = 0.4·25 = 10 mg/h

Answer

D = 10 mg/h

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