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 feature suggests a newborn is preterm rather than term?

  1. ACreases covering the whole sole
  2. BFirm ear cartilage that springs back
  3. CLabia majora covering the labia minora
  4. DPlantar creases only on the front of the sole
2.Maternity & obstetric nursingHard

After fundal massage, the uterus remains boggy and bleeding is heavy. What is the priority next action?

  1. ACall for help and give the prescribed uterotonic, such as oxytocin, per protocol
  2. BOffer oral fluids and check again in an hour
  3. CKeep massaging the fundus firmly on her own for 30 minutes before calling the team
  4. DSit the woman up in high Fowler's position
3.Dosage calculationsMedium
024681010 mL

A child weighing 12 kg is prescribed 15 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

12 kg15 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 265 micrograms. The ampoule contains 0.5 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

265 mcg0.5 mg/mL
V = mL
5.IV infusion ratesMedium
1000 mL15 gtt/mL4 h? gtt/min

Infuse 1000 mL over 4 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL4 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
450 mL15 gtt/mL20 gtt/mint = ? h

A drip runs at 20 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.

20 gtt/min15 gtt/mL450 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Plantar creases only on the front of the sole

Why this is the answer

Preterm babies have few plantar creases, abundant lanugo, flat areolae, soft ears, prominent labia minora and an extended posture. Creases over the whole sole suggest a term baby.

Answer

D · Plantar creases only on the front of the sole
2.Maternity & obstetric nursing

Answer: A · Call for help and give the prescribed uterotonic, such as oxytocin, per protocol

Why this is the answer

Ongoing bleeding with poor tone needs immediate escalation and uterotonics, while continuing massage, emptying the bladder, monitoring vital signs, keeping IV access and measuring blood loss. Delaying help is the dangerous option.

Answer

A · Call for help and give the prescribed uterotonic, such as oxytocin, per protocol
3.Dosage calculations

Answer: V = 7.2 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 = 15·12 = 180 mg

Volume

V = 180/25 = 7.2 mL

On the syringe

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

Answer

V = 7.2 mL
4.Dosage calculations

Answer: V = 0.53 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.

Same units

0.5 mg/mL = 500 mcg/mL

Volume

V = 265/500 = 0.53 mL

Answer

V = 0.53 mL
5.IV infusion rates

Answer: R = 63 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

4·60 = 240 min

Drip rate

R = 1000·15/240 = 62.5 ≈ 63 gtt/min

Answer

R = 63 gtt/min

At the bedside you round to the nearest whole drop: 63 gtt/min.

6.IV infusion rates

Answer: t = 5.6 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

20·60/15 = 80 mL/h

Time left

t = 450/80 = 5.625 ≈ 5.6 h

Answer

t = 5.6 h

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