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's blood glucose is low but the baby is well and able to feed. What is the usual first step?

  1. AFeed the baby and recheck the glucose
  2. BWithhold feeds and observe for 6 hours
  3. CGive IV insulin immediately
  4. DGive the baby plain water by bottle
2.Maternity & obstetric nursingHard

Which statement by a woman in early labour shows a need for further teaching about pain relief?

  1. A"A warm bath or shower may ease the pain."
  2. B"Changing position often and walking can help me cope."
  3. C"Breathing slowly and focusing can help between contractions."
  4. D"If I have an epidural, I will not need my blood pressure checked."
3.Dosage calculationsMedium
80 kg5 mg/kg/day2× per dayD = ? mg

A patient weighs 80 kg. The prescribed dose is 5 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?

80 kg5 mg/kg/day2× per day
D = mg
4.Dosage calculationsHard
250 mg/5 mLV = ? mL

A child weighing 16 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 250 mg in 5 mL. What volume V do you give?

16 kg15 mg/kg250 mg/5 mL
V = mL
5.IV infusion ratesMedium
200 mLleft? mL/h2 h left

1000 mL was ordered over 12 hours. After 10 hours you find that 200 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 / 12 hafter 10 h: 200 mL
R = mL/h
6.IV infusion ratesHard
200 mg250 mL3 mL/h? mcg/min

An infusion of 200 mg in 250 mL runs at 3 mL/h. How many micrograms per minute D does the patient receive?

200 mg/250 mL3 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: A · Feed the baby and recheck the glucose

Why this is the answer

For mild, asymptomatic hypoglycaemia, early feeding and buccal glucose gel are used, with glucose rechecked per protocol. Symptomatic or persistent hypoglycaemia needs IV glucose.

Answer

A · Feed the baby and recheck the glucose
2.Maternity & obstetric nursing

Answer: D · "If I have an epidural, I will not need my blood pressure checked."

Why this is the answer

Epidurals often cause hypotension, so blood pressure is checked frequently after they are started. Movement, breathing techniques and warm water are effective non-drug measures.

Answer

D · "If I have an epidural, I will not need my blood pressure checked."
3.Dosage calculations

Answer: D = 200 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

5·80 = 400 mg

Per dose

D = 400/2 = 200 mg

Answer

D = 200 mg
4.Dosage calculations

Answer: V = 4.8 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

15·16 = 240 mg

Volume

V = (240/250)·5 = 4.8 mL

Answer

V = 4.8 mL
5.IV infusion rates

Answer: R = 100 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

1000/12 = 83.33 mL/h

New rate

R = 200/2 = 100 mL/h

Answer

R = 100 mL/h

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

6.IV infusion rates

Answer: D = 40 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

200000 mcg/250 mL = 800 mcg/mL

Dose per hour

3·800 = 2400 mcg/h

Dose per minute

D = 2400/60 = 40 mcg/min

Answer

D = 40 mcg/min

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