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

What is a "reactive" non-stress test?

  1. ALate decelerations with every contraction
  2. BA baseline heart rate above 160 bpm
  3. CAt least 2 fetal heart rate accelerations within 20 minutes
  4. DNo accelerations of the fetal heart rate within 40 minutes
2.Maternity & obstetric nursingHard

A woman with gestational diabetes on insulin asks about her baby after birth. Which statement by the nurse is accurate?

  1. AThe baby will be born with diabetes
  2. BThe baby will need insulin for the first days
  3. CThe baby's glucose will be checked for hypoglycaemia
  4. DThe baby must not be breastfed in the first week
3.Dosage calculationsMedium
22 kg15 mg/kgD = ? mg

A patient weighs 22 kg and is prescribed 15 mg/kg as a single dose. Find the dose D in mg.

22 kg15 mg/kg
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 215 micrograms. The ampoule contains 0.5 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

215 mcg0.5 mg/mL
V = mL
5.IV infusion ratesMedium
250 mL60 gtt/mL4 h? gtt/min

Infuse 250 mL over 4 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL4 h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
200 mg250 mL20 mL/h? mg/h

A bag contains 200 mg of a drug in 250 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?

200 mg/250 mL20 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: C · At least 2 fetal heart rate accelerations within 20 minutes

Why this is the answer

A reactive non-stress test shows at least two qualifying accelerations in 20 minutes and indicates fetal well-being. A non-reactive test needs further testing, such as a biophysical profile.

Answer

C · At least 2 fetal heart rate accelerations within 20 minutes
2.Maternity & obstetric nursing

Answer: C · The baby's glucose will be checked for hypoglycaemia

Why this is the answer

Babies of mothers with diabetes may have high insulin levels after birth, causing hypoglycaemia. Early, frequent feeding, often skin-to-skin, and glucose monitoring per protocol are standard.

Answer

C · The baby's glucose will be checked for hypoglycaemia
3.Dosage calculations

Answer: D = 330 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.

Dose

15·22 = 330 mg

Answer

D = 330 mg
4.Dosage calculations

Answer: V = 0.43 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 = 215/500 = 0.43 mL

Answer

V = 0.43 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 = 250·60/240 = 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: D = 16 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

200/250 = 0.8 mg/mL

Dose rate

D = 0.8·20 = 16 mg/h

Answer

D = 16 mg/h

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