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 is pregnant. She previously had twins at 35 weeks (both alive) and a miscarriage at 10 weeks. What is her GTPAL?

  1. AG3 T0 P1 A1 L2
  2. BG3 T1 P0 A1 L2
  3. CG2 T0 P1 A1 L2
  4. DG4 T0 P2 A1 L2
2.Maternity & obstetric nursingHard

Over the last hour, a labour tracing shows variable decelerations that are becoming deeper and longer, a baseline rising from 135 to 165 bpm and falling variability. How should the nurse interpret this?

  1. ABenign head compression; continue routine monitoring
  2. BA sign of fetal well-being; no action is needed
  3. CEvolving fetal hypoxia; escalate for urgent obstetric review
  4. DA normal fetal sleep cycle; recheck in an hour
3.Dosage calculationsMedium
12 kg7.5 mg/kg/day3× per dayD = ? mg

A patient weighs 12 kg. The prescribed dose is 7.5 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

12 kg7.5 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1.1 mg. The ampoule contains 2000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1.1 mg2000 mcg/mL
V = mL
5.IV infusion ratesMedium
1000 mL20 gtt/mL6 h? gtt/min

Infuse 1000 mL over 6 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL6 h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
50 mg250 mL10 mL/h? mcg/min

An infusion of 50 mg in 250 mL runs at 10 mL/h. How many micrograms per minute D does the patient receive?

50 mg/250 mL10 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: A · G3 T0 P1 A1 L2

Why this is the answer

Gravida includes the current pregnancy: 3. The twins were preterm (20–36 weeks) and count as one birth: T0 P1. The miscarriage gives A1, and 2 children are living: L2. Counting the twins twice gives the G4 P2 mistake.

Answer

A · G3 T0 P1 A1 L2
2.Maternity & obstetric nursing

Answer: C · Evolving fetal hypoxia; escalate for urgent obstetric review

Why this is the answer

Deepening decelerations with a rising baseline and falling variability show that the fetus is losing its ability to compensate. Intrauterine resuscitation (position change, stopping any oxytocin, treating hypotension) starts and the obstetrician is called urgently, because expedited birth may be needed.

Answer

C · Evolving fetal hypoxia; escalate for urgent obstetric review
3.Dosage calculations

Answer: D = 30 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

7.5·12 = 90 mg

Per dose

D = 90/3 = 30 mg

Answer

D = 30 mg
4.Dosage calculations

Answer: V = 0.55 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

1.1 mg = 1100 mcg

Volume

V = 1100/2000 = 0.55 mL

Answer

V = 0.55 mL
5.IV infusion rates

Answer: R = 56 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 = 1000·20/360 = 55.56 ≈ 56 gtt/min

Answer

R = 56 gtt/min

At the bedside you round to the nearest whole drop: 56 gtt/min.

6.IV infusion rates

Answer: D = 33.33 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

10·200 = 2000 mcg/h

Dose per minute

D = 2000/60 = 33.33 mcg/min

Answer

D = 33.33 mcg/min

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