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

A woman with gestational diabetes asks if she will have diabetes after the baby is born. Which reply is accurate?

  1. AIt never returns, so no further glucose testing is needed after birth
  2. BIt will continue unless she stops breastfeeding
  3. CIt usually resolves, but her risk of type 2 diabetes stays higher
  4. DIt always becomes type 1 diabetes after birth
3.Dosage calculationsMedium
60 kg15 mg/kgD = ? mg

A patient weighs 60 kg and is prescribed 15 mg/kg as a single dose. Find the dose D in mg.

60 kg15 mg/kg
D = mg
4.Dosage calculationsHard
37 kg125 cmBSA = √(h·w/3600)135 mg/m²D = ? mg

A patient is 125 cm tall and weighs 37 kg. The prescription is 135 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

125 cm37 kg135 mg/m²
D = mg
5.IV infusion ratesMedium
210 mLleft? mL/h2 h left

1000 mL was ordered over 10 hours. After 8 hours you find that 210 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?

1000 mL / 10 hafter 8 h: 210 mL
R = mL/h
6.IV infusion ratesHard
400 mg500 mL15 mL/h? mg/h

A bag contains 400 mg of a drug in 500 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?

400 mg/500 mL15 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: C · 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

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

Answer: C · It usually resolves, but her risk of type 2 diabetes stays higher

Why this is the answer

Gestational diabetes usually resolves after birth, but the risk of later type 2 diabetes is much higher. She should have a glucose test after birth and regular screening, and keep up a healthy weight and activity.

Answer

C · It usually resolves, but her risk of type 2 diabetes stays higher
3.Dosage calculations

Answer: D = 900 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

15·60 = 900 mg

Answer

D = 900 mg
4.Dosage calculations

Answer: D = 153 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Body surface area

BSA = √(125·37/3600) = √1.285 = 1.133 m²

Dose

D = 135·1.133 = 153 mg

Answer

D = 153 mg
5.IV infusion rates

Answer: R = 105 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

1000/10 = 100 mL/h

New rate

R = 210/2 = 105 mL/h

Answer

R = 105 mL/h

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

6.IV infusion rates

Answer: D = 12 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

400/500 = 0.8 mg/mL

Dose rate

D = 0.8·15 = 12 mg/h

Answer

D = 12 mg/h

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