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

What should parents be taught about the water for a newborn's bath?

  1. AUse very hot water so that germs on the skin are killed
  2. BLeave the baby briefly if the water is only shallow
  3. CAdd adult bubble bath to soften the baby's skin
  4. DCheck that it is warm, not hot, before the baby goes in
2.Maternity & obstetric nursingHard

One hour after birth, the large baby of a mother with diabetes is jittery and feeding poorly. What should the nurse do first?

  1. AWrap the baby tightly and recheck in 4 hours
  2. BGive a bath to wake the baby up
  3. CCheck the baby's blood glucose
  4. DReassure the parents that jitteriness is normal
3.Dosage calculationsMedium
024681010 mL

A child weighing 29 kg is prescribed 2 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?

29 kg2 mg/kg10 mg/mL
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 435 micrograms. The ampoule contains 0.5 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

435 mcg0.5 mg/mL
V = mL
5.IV infusion ratesMedium
500 mL60 gtt/mL8 h? gtt/min

Infuse 500 mL over 8 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL8 h60 gtt/mL
R = gtt/min
6.IV infusion ratesHard
500 mg500 mL60 gtt/mL50 mg/h? gtt/min

500 mg of a drug is diluted in 500 mL and given by gravity through a set of 60 gtt/mL. The order is 50 mg per hour. Find the drip rate R in drops per minute.

500 mg/500 mL50 mg/h60 gtt/mL
R = gtt/min

3Solutions

1.Maternity & obstetric nursing

Answer: D · Check that it is warm, not hot, before the baby goes in

Why this is the answer

Bath water should be comfortably warm, about 37 °C (98.6 °F), checked with a thermometer or the elbow, and the baby is never left alone, even in shallow water. Plain water or a mild baby cleanser is used. Some guidance, such as in the US, advises sponge baths until the cord stump has fallen off.

Answer

D · Check that it is warm, not hot, before the baby goes in
2.Maternity & obstetric nursing

Answer: C · Check the baby's blood glucose

Why this is the answer

Jitteriness and poor feeding in a high-risk newborn suggest hypoglycaemia. A point-of-care glucose check guides treatment, such as feeding or glucose gel per protocol, with escalation if the level stays low.

Answer

C · Check the baby's blood glucose
3.Dosage calculations

Answer: V = 5.8 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 = 2·29 = 58 mg

Volume

V = 58/10 = 5.8 mL

On the syringe

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

Answer

V = 5.8 mL
4.Dosage calculations

Answer: V = 0.87 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

0.5 mg/mL = 500 mcg/mL

Volume

V = 435/500 = 0.87 mL

Answer

V = 0.87 mL
5.IV infusion rates

Answer: R = 63 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

8·60 = 480 min

Drip rate

R = 500·60/480 = 62.5 ≈ 63 gtt/min

Answer

R = 63 gtt/min

At the bedside you round to the nearest whole drop: 63 gtt/min.

6.IV infusion rates

Answer: R = 50 gtt/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

500/500 = 1 mg/mL

Volume per hour

50/1 = 50 mL/h

Drip rate

R = 50·60/60 = 50 gtt/min

Answer

R = 50 gtt/min

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