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

How does breast milk jaundice usually differ from early breastfeeding jaundice?

  1. AIt is caused by too little milk intake
  2. BIt appears in the first 24 hours in a sick baby
  3. CIt appears later, after the first week, in a thriving baby
  4. DIt always needs the baby to stop breastfeeding permanently
2.Maternity & obstetric nursingHard

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

  1. A"I will tell my midwife or doctor if I have thoughts of harming myself."
  2. B"If I take medicine I can never breastfeed again."
  3. C"I should keep my feelings to myself so I don't worry my family."
  4. D"Depression after birth means I am a bad mother."
3.Dosage calculationsMedium
25 kg15 mg/kgD = ? mg

A patient weighs 25 kg and is prescribed 15 mg/kg as a single dose. Find the dose D in mg.

25 kg15 mg/kg
D = mg
4.Dosage calculationsHard
40k units500 mL? mL/h500 units/h

An infusion contains 40000 units of a drug in 500 mL. The prescription is 500 units per hour. At what rate R do you set the pump, in mL/h?

40000 units/500 mL500 units/h
R = mL/h
5.IV infusion ratesMedium
V = ?60 gtt/mL30 gtt/min12 h

A drip runs at 30 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 12 hours?

30 gtt/min60 gtt/mL12 h
V = mL
6.IV infusion ratesHard
500 mg250 mL20 mL/h? mg/h

A bag contains 500 mg of a drug in 250 mL and runs at 20 mL/h. How many milligrams per hour D does the patient receive?

500 mg/250 mL20 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: C · It appears later, after the first week, in a thriving baby

Why this is the answer

Breast milk jaundice begins after the first week and can last several weeks in an otherwise healthy, well-fed baby. It is thought to be caused by substances in milk and rarely needs breastfeeding to stop.

Answer

C · It appears later, after the first week, in a thriving baby
2.Maternity & obstetric nursing

Answer: A · "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

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

Answer: D = 375 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.

Dose

15·25 = 375 mg

Answer

D = 375 mg
4.Dosage calculations

Answer: R = 6.25 mL/h

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.

Concentration

40000/500 = 80 units/mL

Pump rate

R = 500/80 = 6.25 mL/h

Answer

R = 6.25 mL/h
5.IV infusion rates

Answer: V = 360 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

30·60/60 = 30 mL/h

Volume

V = 30·12 = 360 mL

Answer

V = 360 mL
6.IV infusion rates

Answer: D = 40 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

500/250 = 2 mg/mL

Dose rate

D = 2·20 = 40 mg/h

Answer

D = 40 mg/h

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