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

Where is the fundus normally found about 12 hours after a vaginal birth?

  1. ASoft and two finger-widths above the xiphoid process
  2. BFirm, in the midline, at about the level of the umbilicus
  3. CFirm and displaced to the far left side
  4. DBelow the symphysis pubis and not palpable
2.Maternity & obstetric nursingHard

At 7 weeks of pregnancy, a woman reports sudden severe pain on one side of the lower abdomen, pain in the shoulder tip and dizziness. What should the nurse suspect?

  1. ANormal round ligament pain caused by the growing uterus
  2. BBraxton Hicks contractions
  3. CHyperemesis gravidarum
  4. DA ruptured ectopic pregnancy with internal bleeding
3.Dosage calculationsMedium
024681010 mL

A child weighing 9 kg is prescribed 10 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

9 kg10 mg/kg50 mg/mL
V = mL
4.Dosage calculationsHard
20k units250 mL? mL/h2000 units/h

An infusion contains 20000 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?

20000 units/250 mL2000 units/h
R = mL/h
5.IV infusion ratesMedium
250 mL15 gtt/mL2 h? gtt/min

Infuse 250 mL over 2 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL2 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
100 mg50 mL30 mL/h? mg/h

A bag contains 100 mg of a drug in 50 mL and runs at 30 mL/h. How many milligrams per hour D does the patient receive?

100 mg/50 mL30 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Firm, in the midline, at about the level of the umbilicus

Why this is the answer

The fundus rises to about the umbilicus within the first 12 hours, then descends about 1 cm (one finger-width) a day. It is usually no longer palpable above the symphysis by about 2 weeks.

Answer

B · Firm, in the midline, at about the level of the umbilicus
2.Maternity & obstetric nursing

Answer: D · A ruptured ectopic pregnancy with internal bleeding

Why this is the answer

One-sided pain, shoulder-tip pain and dizziness early in pregnancy suggest a ruptured ectopic pregnancy. It is an emergency: monitor vital signs, obtain IV access and get urgent medical help.

Answer

D · A ruptured ectopic pregnancy with internal bleeding
3.Dosage calculations

Answer: V = 1.8 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 = 10·9 = 90 mg

Volume

V = 90/50 = 1.8 mL

On the syringe

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

Answer

V = 1.8 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

20000/250 = 80 units/mL

Pump rate

R = 2000/80 = 25 mL/h

Answer

R = 25 mL/h
5.IV infusion rates

Answer: R = 31 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

2·60 = 120 min

Drip rate

R = 250·15/120 = 31.25 ≈ 31 gtt/min

Answer

R = 31 gtt/min

At the bedside you round to the nearest whole drop: 31 gtt/min.

6.IV infusion rates

Answer: D = 60 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

100/50 = 2 mg/mL

Dose rate

D = 2·30 = 60 mg/h

Answer

D = 60 mg/h

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