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

Why is the hearing of newborns screened before discharge or soon after birth?

  1. AIt is required before vitamin K can be given
  2. BHearing loss can be cured with a single injection
  3. CEarly support improves language development
  4. DIt detects congenital heart disease
2.Maternity & obstetric nursingHard

A newborn passed no meconium by 48 hours and has a swollen abdomen and green vomiting. Which condition should be suspected?

  1. ADevelopmental hip dysplasia
  2. BPhysiological jaundice
  3. CHirschsprung disease
  4. DErythema toxicum
3.Dosage calculationsMedium
15 kg2 mg/kgD = ? mg

A patient weighs 15 kg and is prescribed 2 mg/kg as a single dose. Find the dose D in mg.

15 kg2 mg/kg
D = mg
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 780 micrograms. The ampoule contains 1 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

780 mcg1 mg/mL
V = mL
5.IV infusion ratesMedium
V = ?15 gtt/mL30 gtt/min2 h

A drip runs at 30 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 2 hours?

30 gtt/min15 gtt/mL2 h
V = mL
6.IV infusion ratesHard
750 mL60 gtt/mL40 gtt/mint = ? h

A drip runs at 40 gtt/min through a set of 60 gtt/mL. There are 750 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

40 gtt/min60 gtt/mL750 mL
t = h

3Solutions

1.Maternity & obstetric nursing

Answer: C · Early support improves language development

Why this is the answer

Early detection of hearing loss allows hearing aids, cochlear implants or other support in the first months, which greatly improves language outcomes.

Answer

C · Early support improves language development
2.Maternity & obstetric nursing

Answer: C · Hirschsprung disease

Why this is the answer

Delayed meconium, abdominal distension and bilious vomiting suggest bowel obstruction, such as Hirschsprung disease. Bilious vomiting in a newborn is always an emergency.

Answer

C · Hirschsprung disease
3.Dosage calculations

Answer: D = 30 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

2·15 = 30 mg

Answer

D = 30 mg
4.Dosage calculations

Answer: V = 0.78 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

1 mg/mL = 1000 mcg/mL

Volume

V = 780/1000 = 0.78 mL

Answer

V = 0.78 mL
5.IV infusion rates

Answer: V = 240 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

30·60/15 = 120 mL/h

Volume

V = 120·2 = 240 mL

Answer

V = 240 mL
6.IV infusion rates

Answer: t = 18.8 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.

Rate in mL/h

40·60/60 = 40 mL/h

Time left

t = 750/40 = 18.75 ≈ 18.8 h

Answer

t = 18.8 h

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