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 newborn complication is particularly linked to a forceps birth?

  1. AUmbilical hernia
  2. BNeonatal jaundice from ABO incompatibility
  3. CHip dysplasia
  4. DFacial nerve palsy
2.Maternity & obstetric nursingHard

A woman 1 day after a caesarean asks how to hold her baby for breastfeeding without pressure on her wound. Which position is best?

  1. AStanding up while breastfeeding
  2. BThe football (rugby) hold or side-lying
  3. CThe cradle hold with the baby across the incision
  4. DLying flat on her back with the baby on her abdomen
3.Dosage calculationsMedium
024681010 mL

A child weighing 21 kg is prescribed 2 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

21 kg2 mg/kg10 mg/mL
V = mL
4.Dosage calculationsHard
79 kg185 cmBSA = √(h·w/3600)135 mg/m²D = ? mg

A patient is 185 cm tall and weighs 79 kg. The prescription is 135 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

185 cm79 kg135 mg/m²
D = mg
5.IV infusion ratesMedium
1500 mL10 gtt/mL6 h? gtt/min

Infuse 1500 mL over 6 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1500 mL6 h10 gtt/mL
R = gtt/min
6.IV infusion ratesHard
50 mg250 mL18 mL/h? mcg/min

An infusion of 50 mg in 250 mL runs at 18 mL/h. How many micrograms per minute D does the patient receive?

50 mg/250 mL18 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: D · Facial nerve palsy

Why this is the answer

Pressure from forceps blades on the facial nerve can cause temporary facial palsy, with asymmetry when the baby cries. It usually resolves within weeks.

Answer

D · Facial nerve palsy
2.Maternity & obstetric nursing

Answer: B · The football (rugby) hold or side-lying

Why this is the answer

The football hold places the baby along her side, and side-lying avoids any pressure on the abdomen. A pillow over the wound also helps.

Answer

B · The football (rugby) hold or side-lying
3.Dosage calculations

Answer: V = 4.2 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 = 2·21 = 42 mg

Volume

V = 42/10 = 4.2 mL

On the syringe

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

Answer

V = 4.2 mL
4.Dosage calculations

Answer: D = 272 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Body surface area

BSA = √(185·79/3600) = √4.06 = 2.015 m²

Dose

D = 135·2.015 = 272 mg

Answer

D = 272 mg
5.IV infusion rates

Answer: R = 42 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 = 1500·10/360 = 41.67 ≈ 42 gtt/min

Answer

R = 42 gtt/min

At the bedside you round to the nearest whole drop: 42 gtt/min.

6.IV infusion rates

Answer: D = 60 mcg/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

50000 mcg/250 mL = 200 mcg/mL

Dose per hour

18·200 = 3600 mcg/h

Dose per minute

D = 3600/60 = 60 mcg/min

Answer

D = 60 mcg/min

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