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 newborn baby girl has a small amount of blood-tinged vaginal discharge on day 3. What should the nurse tell the parents?

  1. AIt means the baby has a bleeding disorder
  2. BIt shows a urinary tract infection
  3. CIt is a sign of sexual abuse
  4. DIt is caused by maternal hormones
2.Maternity & obstetric nursingHard

Which statement by a pregnant woman with gestational diabetes shows she understands her care?

  1. A"Insulin will harm my baby, so I will refuse it."
  2. B"I will check my glucose as shown and record it."
  3. C"I can skip meals if my glucose is high in the morning."
  4. D"My baby's growth will not need monitoring."
3.Dosage calculationsMedium
024681010 mL

A child weighing 30 kg is prescribed 2 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

30 kg2 mg/kg20 mg/mL
V = mL
4.Dosage calculationsHard
125 mg/5 mLV = ? mL

A child weighing 14 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?

14 kg20 mg/kg125 mg/5 mL
V = mL
5.IV infusion ratesMedium
60 gtt/mL80 mL/h? gtt/min

An infusion is ordered at 80 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

80 mL/h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
50 mg500 mL6 mL/h? mcg/min

An infusion of 50 mg in 500 mL runs at 6 mL/h. How many micrograms per minute D does the patient receive?

50 mg/500 mL6 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: D · It is caused by maternal hormones

Why this is the answer

Pseudomenstruation is caused by withdrawal of maternal hormones after birth and resolves within days. Swollen breasts in either sex have the same cause.

Answer

D · It is caused by maternal hormones
2.Maternity & obstetric nursing

Answer: B · "I will check my glucose as shown and record it."

Why this is the answer

Regular glucose monitoring with records guides treatment changes. Skipping meals can cause hypoglycaemia and ketosis, insulin does not cross the placenta in a meaningful amount, and fetal growth is monitored.

Answer

B · "I will check my glucose as shown and record it."
3.Dosage calculations

Answer: V = 3 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 = 2·30 = 60 mg

Volume

V = 60/20 = 3 mL

On the syringe

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

Answer

V = 3 mL
4.Dosage calculations

Answer: V = 11.2 mL

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 from weight

20·14 = 280 mg

Volume

V = (280/125)·5 = 11.2 mL

Answer

V = 11.2 mL
5.IV infusion rates

Answer: R = 80 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.

Millilitres per minute

80/60 = 1.333 mL/min

Drip rate

R = 1.333·60 = 80 gtt/min

Answer

R = 80 gtt/min

With a microdrip set (60 gtt/mL), gtt/min equals mL/h.

6.IV infusion rates

Answer: D = 10 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/500 mL = 100 mcg/mL

Dose per hour

6·100 = 600 mcg/h

Dose per minute

D = 600/60 = 10 mcg/min

Answer

D = 10 mcg/min

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