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

The fetus is in the left occiput anterior position. Where is the fetal heart usually heard best?

  1. AAbove the umbilicus on the mother's right side
  2. BDirectly over the fundus
  3. CAbove the umbilicus on the mother's left side
  4. DBelow the umbilicus on the mother's left side
2.Maternity & obstetric nursingHard

A breastfeeding mother has a hard, tender lump in one breast without fever. She feels well. What is the most likely cause and the best advice?

  1. AA blocked duct; keep feeding and vary positions
  2. BMastitis; stop feeding from that breast
  3. CA breast abscess; stop breastfeeding completely
  4. DBreast cancer; stop breastfeeding at once
3.Dosage calculationsMedium
024681010 mL

A child weighing 10 kg is prescribed 4 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

10 kg4 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
25k units250 mL? mL/h2000 units/h

An infusion contains 25000 units of a drug in 250 mL. The prescription is 2000 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/250 mL2000 units/h
R = mL/h
5.IV infusion ratesMedium
20 gtt/mL60 mL/h? gtt/min

An infusion is ordered at 60 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.

60 mL/h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
4 g500 mL? mL/h2 mg/min

A bag contains 4 g of a drug in 500 mL. The order is 2 mg per minute. At what rate R do you set the pump, in mL/h?

4 g/500 mL2 mg/min
R = mL/h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Below the umbilicus on the mother's left side

Why this is the answer

The fetal heart is heard most clearly through the fetal back. In a cephalic LOA position, that is in the lower left quadrant. In breech presentations, it is usually heard above the umbilicus.

Answer

D · Below the umbilicus on the mother's left side
2.Maternity & obstetric nursing

Answer: A · A blocked duct; keep feeding and vary positions

Why this is the answer

A tender lump without fever usually means a blocked duct. Frequent feeding, varied positions and gentle care help clear it. Fever, redness and flu-like symptoms suggest mastitis, which also usually allows continued feeding.

Answer

A · A blocked duct; keep feeding and vary positions
3.Dosage calculations

Answer: V = 1.6 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 = 4·10 = 40 mg

Volume

V = 40/25 = 1.6 mL

On the syringe

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

Answer

V = 1.6 mL
4.Dosage calculations

Answer: R = 20 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

25000/250 = 100 units/mL

Pump rate

R = 2000/100 = 20 mL/h

Answer

R = 20 mL/h
5.IV infusion rates

Answer: R = 20 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

60/60 = 1 mL/min

Drip rate

R = 1·20 = 20 gtt/min

Answer

R = 20 gtt/min
6.IV infusion rates

Answer: R = 15 mL/h

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

4000 mg/500 mL = 8 mg/mL

Dose per hour

2·60 = 120 mg/h

Pump rate

R = 120/8 = 15 mL/h

Answer

R = 15 mL/h

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