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

Why is it important that the uterus relaxes fully between contractions?

  1. ABlood flow to the placenta is restored between contractions
  2. BIt prevents the membranes from rupturing
  3. CIt allows the cervix to close again between contractions
  4. DIt reduces the mother's need for fluids
2.Maternity & obstetric nursingHard

Which postpartum woman should the nurse assess first?

  1. ADay 3: full, firm, tender breasts
  2. BOne hour after birth: heart rate 118/min and a boggy fundus
  3. CDay 1: moderate lochia rubra with a few clots smaller than a coin
  4. DDay 2: cramping during breastfeeding
3.Dosage calculationsMedium
60 kg30 mg/kg/day3× per dayD = ? mg

A patient weighs 60 kg. The prescribed dose is 30 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

60 kg30 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 350 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

350 units1000 units/mL
V = mL
5.IV infusion ratesMedium
15 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 15 gtt/mL. Find the drip rate R in drops per minute.

60 mL/h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
450 mL15 gtt/mL30 gtt/mint = ? h

A drip runs at 30 gtt/min through a set of 15 gtt/mL. There are 450 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

30 gtt/min15 gtt/mL450 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: A · Blood flow to the placenta is restored between contractions

Why this is the answer

During contractions, blood flow to the intervillous space falls. Relaxation between contractions restores oxygen delivery to the fetus. Short rest periods, as in tachysystole, can cause fetal hypoxia.

Answer

A · Blood flow to the placenta is restored between contractions
2.Maternity & obstetric nursing

Answer: B · One hour after birth: heart rate 118/min and a boggy fundus

Why this is the answer

A boggy uterus with tachycardia in the first hour suggests haemorrhage and needs immediate assessment. Small clots on day 1, afterpains and engorgement on day 3 are expected.

Answer

B · One hour after birth: heart rate 118/min and a boggy fundus
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.

Total per day

30·60 = 1800 mg

Per dose

D = 1800/3 = 600 mg

Answer

D = 600 mg
4.Dosage calculations

Answer: V = 0.35 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 = 350/1000 = 0.35 mL

On the syringe

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

Answer

V = 0.35 mL
5.IV infusion rates

Answer: R = 15 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 = 1·15 = 15 gtt/min

Answer

R = 15 gtt/min
6.IV infusion rates

Answer: t = 3.8 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

30·60/15 = 120 mL/h

Time left

t = 450/120 = 3.75 ≈ 3.8 h

Answer

t = 3.8 h

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