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

Why is tight glucose control before conception important in women with pre-existing diabetes?

  1. AEarly hyperglycaemia raises the risk of birth defects
  2. BIt guarantees that the baby will be born at term
  3. CIt prevents the mother from developing pre-eclampsia
  4. DIt prevents the need for any monitoring during pregnancy
2.Maternity & obstetric nursingHard

Which statement by a woman with postnatal depression shows that the nurse's teaching has been effective?

  1. A"Depression after birth means I am a bad mother."
  2. B"If I take medicine I can never breastfeed again."
  3. C"I will tell my midwife or doctor if I have thoughts of harming myself."
  4. D"I should keep my feelings to myself so I don't worry my family."
3.Dosage calculationsMedium
15 kg2 mg/kg/day3× per dayD = ? mg

A patient weighs 15 kg. The prescribed dose is 2 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

15 kg2 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 2320 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

2320 mcg4 mg/mL
V = mL
5.IV infusion ratesMedium
V = ?15 gtt/mL35 gtt/min4 h

A drip runs at 35 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 4 hours?

35 gtt/min15 gtt/mL4 h
V = mL
6.IV infusion ratesHard
200 mg500 mL20 mL/h? mg/h

A bag contains 200 mg of a drug in 500 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?

200 mg/500 mL20 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: A · Early hyperglycaemia raises the risk of birth defects

Why this is the answer

Hyperglycaemia during organogenesis increases the risk of heart, neural tube and other anomalies and of miscarriage. Good preconception control and high-dose folic acid lower this risk.

Answer

A · Early hyperglycaemia raises the risk of birth defects
2.Maternity & obstetric nursing

Answer: C · "I will tell my midwife or doctor if I have thoughts of harming myself."

Why this is the answer

Teaching aims to reduce shame, encourage support and make clear that thoughts of self-harm must be reported urgently. Many antidepressants are compatible with breastfeeding, and depression is a treatable illness, not a failure.

Answer

C · "I will tell my midwife or doctor if I have thoughts of harming myself."
3.Dosage calculations

Answer: D = 10 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.

Total per day

2·15 = 30 mg

Per dose

D = 30/3 = 10 mg

Answer

D = 10 mg
4.Dosage calculations

Answer: V = 0.58 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

4 mg/mL = 4000 mcg/mL

Volume

V = 2320/4000 = 0.58 mL

Answer

V = 0.58 mL
5.IV infusion rates

Answer: V = 560 mL

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

35·60/15 = 140 mL/h

Volume

V = 140·4 = 560 mL

Answer

V = 560 mL
6.IV infusion rates

Answer: D = 8 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

200/500 = 0.4 mg/mL

Dose rate

D = 0.4·20 = 8 mg/h

Answer

D = 8 mg/h

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