Week 3 Flashcards Preview

Women's Health Clinical Meds > Week 3 > Flashcards

Flashcards in Week 3 Deck (32)
Loading flashcards...
1

oxytocin: trade name

Pitocin

2

oxytocin: indications

  • induction or augmentation of labor
    • must have a favorable cervix (soft, go from posterior-->anterior position, dilate and efface)
  • control of postpartum bleeding
  • inevitable or incomplete abortion
  • antepartum contraction stress test (CST): can help determine if the fetus can tolerate labor by getting 3 contractions in 10 min w/o any nonreassuring signs in FHR (negative-->continue pregnancy; positive-->deliver)

3

oxytocin: dosage for induction or augmentation of labor

  • starting doses of 0.5 to 6 milliunits/min
  • inc the dose to 1-2 milliunits/min every 15-40 min
    • high dose protocols may inc dose in increments of up to 6 milliunits/min
  • after adequate contraction pattern is established and cervix is dilated 5-6 cm, oxytocin may be reduced
  • actual dose based on uterine response and absence of ADRs

4

oxytocin: dosage for control of postpartum bleeding

  • IV: 10-40 units at a rate of 20-40 milliunits/min
    • inc or dec rate according to uterine response and rate of postpartum bleeding
  • IM: 10 units after delivery of placenta

5

oxytocin: dosage for inevitable or incomplete abortion

  • 10 units at a rate of 10-20 milliunits/min

6

oxytocin: ADRs

  • hypertonic uterine activity
  • impaired uterine bloodflow
  • uterine rupture
  • abruptio placentae
  • fetal asphyxia (r/t diminished uterine blood flow)
  • maternal fluid retention-->water intoxication
  • hypotension
  • tachycardia
  • cardiac dysrhythmias
  • subarachnoid hemorrhage

7

oxytocin: nursing implications intrapartum

  • assess fetal HR for at least 20 min before induction AND verify a cephalic fetal presentation w/ Leopold's maneuver or a vaginal exam
    • if nonreassuring FHR or non-cephalic, then do not begin induction until U/S is done
  • observe uterine activity for establishment of effective labor pattern
    • contraction every 2-3 min, duration of 40-90 sec, intensity of 50-80 mmHg
    • watch for hypertonicity: contractions less than 2 min apart, rest interval shorter than 30 sec, duration longer than 90-120 sec, or resting tone greater than 20 mmHg
  • if hypertonicity or nonreassuring FHR occurs, stop infusion, inc rate of nonadditive soln, position woman in side-lying, and administer O2 at 8-10 L/min
  • given by pump
  • titrated according to contraction pattern
  • record BP, pulse, and RR every 30-60 min or with each dose inc

8

oxytocin: nursing implications postpartum

  • administer after delivery of the shoulders of the infant to help uterus contract
  • observe uterus for firmness, height, and deviation
  • massage until firm if uterus is boggy
  • observe lochia for color, quantity, and presence of clots
  • assess for cramping
  • assess V/S every 15 min
  • monitor I&O and breath sounds to identify fluid retention or bladder distention
  • notify provider if uterus fails to remain contracted or lochia is bright red or has clots

9

Misoprostol: trade name

Cytotec

10

Misoprostol: indications

  • cervical ripening
    • make the cervix more favorable so you can administer oxytocin
  • induction of labor
  • termination of pregnancy

11

Misoprostol: dosage

  • 25 mcg vaginally
    • must be prepared by pharmacist--broken from a 100 or 200 mcg tablet
  • 100 mcg orally

12

Misoprostol: ADRs

  • uterine hyperstimulation
  • contraindicated in a womean with previous cesarean or other uterine surgery

13

Misoprostol: nursing implications

  • to reduce leakage, have woman lie flat for 15-20 min after the gel form of PG is inserted
  • FHR should be monitored for at least 30 min for changes
  • uterus should be assessed for excessive contractions
  • oxytocin induction can begin 4 hours after last dose
  • if uterine hypertonicity occurs, place woman in side lying position, provide O2 at 8-10 L/min, administer tocolytic drug (terbutaline or Mg Sulfate)

14

Dinoprostone: classification

Cervidil

15

Dinoprostone: indications

  • cervical ripening
    • make the cervix more favorable so you can administer oxytocin

16

Dinoprostone: dosage

  • 10 mg in a time release vaginal insert left in place for up to 12 hours
    • remove w/ onset of active labor, membrane rupture, or uterine hyperstimulation

17

Dinoprostone: ADRs

  • hypertonic contractions (uterine hypertonicity)
  • amniotic fluid embolism
  • uterine rupture

18

Dinoprostone: nursing implications

  • remove after 12 hours or when active labor begins
  • ADRs can be reduced w/in 15 min after removal
  • if hypertonic uterine activity occurs, remove insert, place woman in side lying position, provide O2 at 8-10 L/min, and administer tocolytic (terbutaline or Mg sulfate)
    • may occur up to 9.5 hours after placement
  • to reduce leakage, have woman lie down for 2 hours after insertion
  • oxytocin induction may begin 30-60 min after removal of insert

19

Butorphanol tartrate: trade name

Stadol

20

butorphanol tartrate: indications

  • systemic pain relief during labor

21

butorphanol tartrate: dosage

  • IV: 1 mg every 3-4 hour
    • range 0.5-2 mg

22

butorphanol tartrate: ADRs

  • respiratory depression or apnea (in woman or fetus)
  • anaphylaxis
  • dizziness, lightheadedness, sedation, lethargy, HA, euphoria, mental clouding, fainting, tremors, delirium, insomnia
  • n/v/constipation/anorexia
  • dry mouth
  • flushing
  • altered HR and BP
  • circulatory collapse
  • urinary retention
  • sensitivity to cold

23

butorphanol tartrate: nursing implications

  • assess for allergies and opiate dependence
  • administer at the beginning or peak of contraction in order to prevent a lot of med going to baby
  • observe V/S and respiratory fcn in woman (at least 12 breaths/min) and newborn (at least 30 breaths/min)
    • have naloxone and resuscitation equipment available
  • report n/v for an order for antiemetic
    • may enhance respiratory depression

24

hydralazine: trade name

Apresoline

25

hydralazine: indications

  • vasodilator to help with pregnancy induced HTN (PIH)
    • used for inpatient management of severe preeclampsia

26

hydralazine: dosage

  • 5 mg q 15–20 min
    • if no response after a total of 20 mg, consider an alternative agent.

27

hydralazine: ADRs

  • tachycardia
  • sodium/fluid retention
  • drug induced lupus
  • n/v/d
  • edema
  • HA
  • dizziness

28

hydralazine: nursing implications

  • monitor BP and pulse frequently
  • administer with meals
  • educate client to continue to take meds even if feeling better
  • monitor weight to assess for edema

29

magnesium sulfate: indications

  • prevention and control of seizures in severe preeclampsia
  • prevention of uterine contractions in preterm labor

30

magnesium sulfate: dosage

  • IV: loading dose then continuous infusion
    • loading dose is 4-6 g administered in 100 mL of IV fluid over 15-20 min
    • continuing infusion to maintain control is 2g/hr
  • may be given IM but will be very painful