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 breastfeeding mother asks how she will know her baby is getting enough milk. Which sign is reassuring by day 5 or 6?

  1. AHer breasts never feel full
  2. BThe baby feeds for exactly 5 minutes each side
  3. CAt least 6 wet nappies a day and yellow stools
  4. DThe baby sleeps for 8 hours without feeding
2.Maternity & obstetric nursingHard

A woman with a history of postnatal depression is pregnant again. What is the most appropriate plan?

  1. APlan early support and monitoring before and after birth
  2. BTell her that breastfeeding will prevent it
  3. CWait to see whether depression returns after birth
  4. DAdvise her that it will not happen again
3.Dosage calculationsMedium
2 g+ 9.2 mLV = ? mL

A vial contains 2 g of powder. The label says: add 9.2 mL of water for injection to give a total volume of 10 mL. The prescription is 160 mg. What volume V of the reconstituted solution do you give?

2 g+ 9.2 mL → 10 mL160 mg
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 400 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

400 mcg2 mg/mL
V = mL
5.IV infusion ratesMedium
V = ?20 gtt/mL35 gtt/min2 h

A drip runs at 35 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 2 hours?

35 gtt/min20 gtt/mL2 h
V = mL
6.IV infusion ratesHard
100 mg250 mL12 mL/h? mcg/min

An infusion of 100 mg in 250 mL runs at 12 mL/h. How many micrograms per minute D does the patient receive?

100 mg/250 mL12 mL/h
D = mcg/min

3Solutions

1.Maternity & obstetric nursing

Answer: C · At least 6 wet nappies a day and yellow stools

Why this is the answer

Signs of adequate intake include 6 or more wet nappies and several yellow stools a day by day 5 or 6, steady weight gain and a content baby after feeds. Most babies regain birth weight by about 2 weeks.

Answer

C · At least 6 wet nappies a day and yellow stools
2.Maternity & obstetric nursing

Answer: A · Plan early support and monitoring before and after birth

Why this is the answer

A past episode increases the risk of recurrence. Early identification, a care plan with mental health services, support and monitoring during pregnancy and after birth are recommended.

Answer

A · Plan early support and monitoring before and after birth
3.Dosage calculations

Answer: V = 0.8 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.

Concentration after mixing

2000 mg/10 mL = 200 mg/mL

Volume

V = 160/200 = 0.8 mL

Answer

V = 0.8 mL
4.Dosage calculations

Answer: V = 0.2 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

2 mg/mL = 2000 mcg/mL

Volume

V = 400/2000 = 0.2 mL

Answer

V = 0.2 mL
5.IV infusion rates

Answer: V = 210 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

35·60/20 = 105 mL/h

Volume

V = 105·2 = 210 mL

Answer

V = 210 mL
6.IV infusion rates

Answer: D = 80 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

100000 mcg/250 mL = 400 mcg/mL

Dose per hour

12·400 = 4800 mcg/h

Dose per minute

D = 4800/60 = 80 mcg/min

Answer

D = 80 mcg/min

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