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 membranes have just ruptured. What should the nurse assess first?

  1. AThe colour of the fluid only
  2. BThe fetal heart rate
  3. CThe degree of cervical effacement
  4. DThe woman's temperature
2.Maternity & obstetric nursingHard

A woman at 26 weeks has a haemoglobin of 95 g/L (9.5 g/dL) and a low ferritin. She is already taking oral iron but has severe side effects. What might be considered?

  1. AStopping iron and waiting until after birth
  2. BIntravenous iron
  3. CDoubling her caffeine intake
  4. DA routine blood transfusion
3.Dosage calculationsMedium
024681010 mL

A child weighing 17 kg is prescribed 4 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

17 kg4 mg/kg10 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 8300 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?

8300 units10000 units/mL
V = mL
5.IV infusion ratesMedium
1500 mL20 gtt/mL6 h? gtt/min

Infuse 1500 mL over 6 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1500 mL6 h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
600 mL15 gtt/mL25 gtt/mint = ? h

A drip runs at 25 gtt/min through a set of 15 gtt/mL. There are 600 mL left in the bag. How many hours t until it is empty?

25 gtt/min15 gtt/mL600 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: B · The fetal heart rate

Why this is the answer

After rupture of the membranes, check the fetal heart rate first to detect cord prolapse or compression. Then record the colour, odour, amount and time of the fluid.

Answer

B · The fetal heart rate
2.Maternity & obstetric nursing

Answer: B · Intravenous iron

Why this is the answer

When oral iron is not tolerated or not effective, intravenous iron may be used in the second and third trimesters. Transfusion is reserved for severe or symptomatic anaemia or acute blood loss.

Answer

B · Intravenous iron
3.Dosage calculations

Answer: V = 6.8 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 = 4·17 = 68 mg

Volume

V = 68/10 = 6.8 mL

On the syringe

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

Answer

V = 6.8 mL
4.Dosage calculations

Answer: V = 0.83 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 = 8300/10000 = 0.83 mL

On the syringe

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

Answer

V = 0.83 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

6·60 = 360 min

Drip rate

R = 1500·20/360 = 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: t = 6 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.

Rate in mL/h

25·60/15 = 100 mL/h

Time left

t = 600/100 = 6 h

Answer

t = 6 h

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