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

A woman at 20 weeks says her gums bleed when she brushes her teeth. What is the best advice?

  1. AAvoid all dental visits until after the baby is born
  2. BStop brushing until the bleeding has settled after birth
  3. CReport it at once because it is a sign of a clotting disorder
  4. DUse a soft brush and keep up routine dental care
2.Maternity & obstetric nursingHard

A woman with known mitral stenosis is pregnant. When is she at greatest risk of heart failure?

  1. AOnly during the first stage of labour
  2. BOnly in the first trimester, when nausea is worst
  3. CRisk is the same at every point in pregnancy
  4. DWhen blood volume peaks in late pregnancy and in the hours after birth
3.Dosage calculationsMedium
024681010 mL

A child weighing 22 kg is prescribed 10 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

22 kg10 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 3.48 mg. The ampoule contains 4000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

3.48 mg4000 mcg/mL
V = mL
5.IV infusion ratesMedium
900 mLleft? mL/h5 h left

1500 mL was ordered over 10 hours. After 5 hours you find that 900 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1500 mL / 10 hafter 5 h: 900 mL
R = mL/h
6.IV infusion ratesHard
1000 mg500 mL8 mL/h? mg/h

A bag contains 1000 mg of a drug in 500 mL and runs at 8 mL/h. How many milligrams per hour D does the patient receive?

1000 mg/500 mL8 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Use a soft brush and keep up routine dental care

Why this is the answer

Gum swelling and bleeding are common because of oestrogen-related vascular changes. Good oral hygiene and routine dental care are safe and recommended in pregnancy.

Answer

D · Use a soft brush and keep up routine dental care
2.Maternity & obstetric nursing

Answer: D · When blood volume peaks in late pregnancy and in the hours after birth

Why this is the answer

Cardiac decompensation is most likely when blood volume peaks in the late second and third trimester and right after birth, when blood from the contracted uterus returns to the circulation. These women need close monitoring postpartum.

Answer

D · When blood volume peaks in late pregnancy and in the hours after birth
3.Dosage calculations

Answer: V = 8.8 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 = 10·22 = 220 mg

Volume

V = 220/25 = 8.8 mL

On the syringe

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

Answer

V = 8.8 mL
4.Dosage calculations

Answer: V = 0.87 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

3.48 mg = 3480 mcg

Volume

V = 3480/4000 = 0.87 mL

Answer

V = 0.87 mL
5.IV infusion rates

Answer: R = 180 mL/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.

Original rate

1500/10 = 150 mL/h

New rate

R = 900/5 = 180 mL/h

Answer

R = 180 mL/h

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

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

1000/500 = 2 mg/mL

Dose rate

D = 2·8 = 16 mg/h

Answer

D = 16 mg/h

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