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

Which nursing measure is used during phototherapy?

  1. AKeep the baby fully clothed under the lights
  2. BRemove the eye shields while the lights are on
  3. CLimit feeds to reduce stooling
  4. DTurn the baby often and monitor hydration
2.Maternity & obstetric nursingHard

A woman at 34 weeks with type 1 diabetes has a blood glucose of 2.8 mmol/L (50 mg/dL), is sweating and shaky but is alert. What should the nurse do first?

  1. ACheck the fetal heart rate before any treatment
  2. BWait until her next meal
  3. CGive fast-acting glucose by mouth and recheck
  4. DGive her usual insulin dose
3.Dosage calculationsMedium
024681010 mL

A child weighing 8 kg is prescribed 5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

8 kg5 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
17 kg100 cmBSA = √(h·w/3600)100 mg/m²D = ? mg

A patient is 100 cm tall and weighs 17 kg. The prescription is 100 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

100 cm17 kg100 mg/m²
D = mg
5.IV infusion ratesMedium
V = ?60 gtt/mL30 gtt/min6 h

A drip runs at 30 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 6 hours?

30 gtt/min60 gtt/mL6 h
V = mL
6.IV infusion ratesHard
400 mg100 mL25 mL/h? mg/h

A bag contains 400 mg of a drug in 100 mL and runs at 25 mL/h. How many milligrams per hour D does the patient receive?

400 mg/100 mL25 mL/h
D = mg/h

3Solutions

1.Maternity & obstetric nursing

Answer: D · Turn the baby often and monitor hydration

Why this is the answer

The baby is undressed except for a small nappy, eyes are shielded, position is changed and temperature and hydration are monitored. Frequent feeds help excrete bilirubin through stools.

Answer

D · Turn the baby often and monitor hydration
2.Maternity & obstetric nursing

Answer: C · Give fast-acting glucose by mouth and recheck

Why this is the answer

An alert patient with hypoglycaemia is given fast-acting oral carbohydrate, then glucose is rechecked after about 15 minutes and followed by a snack or meal. Treating the mother also protects the fetus.

Answer

C · Give fast-acting glucose by mouth and recheck
3.Dosage calculations

Answer: V = 1.6 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 = 5·8 = 40 mg

Volume

V = 40/25 = 1.6 mL

On the syringe

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

Answer

V = 1.6 mL
4.Dosage calculations

Answer: D = 68.72 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 = √(100·17/3600) = √0.4722 = 0.6872 m²

Dose

D = 100·0.6872 = 68.72 mg

Answer

D = 68.72 mg
5.IV infusion rates

Answer: V = 180 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

30·60/60 = 30 mL/h

Volume

V = 30·6 = 180 mL

Answer

V = 180 mL
6.IV infusion rates

Answer: D = 100 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

400/100 = 4 mg/mL

Dose rate

D = 4·25 = 100 mg/h

Answer

D = 100 mg/h

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