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Flashcards in Week 4 Deck (30)
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1

Fentanyl: trade name

Duragesic

2

Fentanyl: indications

  • intrapartum pain management
    • opioid analgesics
    • used as an adjunct to epidural analgesia

3

Fentanyl: dosage

  • 50-100 mcg
    • may be repeated every hour
    • may be given by PCA

4

Fentanyl: ADRs

  • pruritis
  • n/v
  • delayed respiratory depression: for up to 12 hr after administration

5

Fentanyl: nursing implications

  • record baseline maternal V/S and FHR
  • nurse should observe for signs of subarachnoid puncture or intravascular injection
  • assess maternal BP and FHR every 5 min furing first 15 min after administration
    • repeat at 30 min and at 1 hour after procedure
  • assess bladder every 2 hour
    • may need to obtain order for catheter placement
  • observe neonate for respiratory depression (esp if drug given w/in 4 hours of birth)
  • can use adjunctive therapy for nausea (promethazine)
  • have naloxone and respiratory resuscitation equipment ready

6

Bupivicaine: trade name

Marcaine

7

Bupivicaine: indications

  • epidural block
    • for intrapartum pain management
  • local anesthetic: for episiotomy, to repair tear or laceration

8

Bupivicaine: dosage

  • 10-20 mL
    • administer in increments of 3-5 mL
    • do a test dose of 3 mL before full administration

9

Bupivicaine: ADRs

  • maternal hypoTN
  • bladder distention
  • prolonged 2nd stage of labor
  • epidural catheter migration
  • cesarean births
  • maternal fever
  • can cause seizure if injected into vessel

10

Bupivicaine: nursing implications

  • often times administered with epi to prevent bleeding
  • record baseline maternal V/S and FHR
  • nurse should observe for signs of subarachnoid puncture or intravascular injection
  • assess maternal BP and FHR every 5 min furing first 15 min after administration
    • repeat at 30 min and at 1 hour after procedure
  • assess bladder every 2 hour and encourage mom to void
    • may need to obtain order for catheter placement
  • prehydrate woman with LR or NS 
  • displace uterus with wedge under woman's side to enhance placental perfusion
    • assess FHR for signs of impaired placental perfusion
    • if impaired placental perfusion or hypoTN occur: administer nonadditive IV fluid, reposition woman on side, administer 8-10 L/min of O2

 

11

what is the trade name for terbutaline sulfate?

Brethine

12

Terbutaline sulfate: indications

  • tocolytic: management of preterm labor-->inhibition of uterine contractions

13

Terbutaline sulfate: dosage

  • IV: 0.01-0.05 mg/min
    • inc rate by 0.01 mg/min at 10-30 min intervals until contractions or maximum dose of 0.08 mg/min is reached
    • maintain dose for 1 hour, then reduce rate at 30 min intervals to reach minimum maintenance dose when contractions stop
    • continue maintenance dose for 12 horus
  • subQ: intermittent injections of 0.25 mg every 4 hour

14

Terbutaline sulfate: ADRs

  • CV: maternal and fetal tachycardia, palpitations, cardiac dysrhythmias, chest pain, wide pulse pressure
  • resp: dyspnea, chest discomfort
  • CNS: tremors, restlessness, weakness, HA, dizziness
  • metabolic: hypokalemia, hyperglycemia
  • GI: n/v, reduced bowel motility
  • skin: flushing, diaphoresis

15

Terbutaline sulfate: nursing implications

  • do not use for longer than 48-72 hour
  • assess woman's apical HR and lung sounds before administering each dose
    • drug toxicity and d/c drug if: maternal HR over 120 bpm or respiratory findings such as "wet" lung sounds or more rapid rate
  • report all non-reassuring maternal and fetal assessments to physician
  • have propranolol ready as a reversal agent

16

what is the trade name for nifedipine?

Procardia

17

Nifedipine: indications

  • CCB used for tocolysis
    • reduce uterine contractions b/c Ca is essential for muscular contractions (for preterm labor)

18

Nifedipine: dosage

  • oral loading dose: 10-20 mg
  • continued oral therapy: 10-20 mg every 3-6 hr until contractions are rare
    • followed by long acting formulations of 30-60 mg every 8-12 hr until antepartum steroids have been administered

19

Nifedipine: ADRs

  • flushing
  • HA
  • inc in maternal and fetal HR
  • maternal postural hypotension
  • hyperglycemia

20

Nifedipine: nursing implications

  • observe for SEs
  • report maternal pulse greater than 120 bpm
  • educate on possible dizziness or faintness
    • sit or stand slowly and call for assistance if needed

21

what is the trade name for betamethasone?

Celestone

22

Betamethasone: indications

  • acceleration of fetal lung maturity to reduce the incidence and severity of respiratory distress syndrome (RDS)
    • greatest benefits if at least 24 hrs elapse b/w initial dose and birth of preterm infant
    • indicated if gestation b/w 24-34 wks

23

Betamethasone: dosage

  • 12 mg IM for 2 doses, 24 hours apart

24

Betamethasone: ADRs

  • few b/c short term use of drug
  • pulmonary edema possible secondary to sodium and fluid retention
  • fever and elevated pulse rate secondary to infection
  • UTI
  • hyperglycemia

25

Betamethasone: nursing considerations

  • educate woman on potential benefits, but tell her drug cannot prevent all complications of prematurity
  • if woman has diabetes, more frequent blood glucose checks are needed
  • WBCs greater than 20,000 may indicate infection
  • assess lung sounds 
  • report chest pain, heaviness, or dyspnea
  • report pain or burning with urination
  • assess V/S for fever and elevated pulse

26

what is the trade name for Indomethacin?

Indocin

27

Indomethacin: indications

  • tocolytic: to inhibit uterine contractions (for preterm labor)
  • can be used to normalize volume of amniotic fluid if hydramnios is present

28

Indomethacin: dosage

  • loading dose: 50 mg orally

29

Indomethacin: ADRs

  • Maternal:
    • GI: n/v/heartburn
    • asthm ain aspirin sensitive women
    • inc BP in hypertensive women
  • Fetal:
    • constriction of ductus arteriosus
    • pulmonary HTN
    • oligohydramnios (usually returns to normal when drug is d/c)

30

Indomethacin: nursing implications

  • limit use to preterm labor before 32 weeks gestation
  • use for no longer than 48-72 consecutive hours
  • observe for GI SEs
  • observe for abnormal bleeding (such as prolonged bleeding after injection and bruising with no apparent cause)
  • watch for signs of infection, b/c drug may mask them
  • check height of fundus at beginning of therapy and daily thereafter to identify reduced amniotic fluid
  • observe for decreased fetal movements and absent FHR accelerations w/ fetal movement (may indicate fetal condition deteriorating)
  • use U/S and fetal echocardiography to determine if drug having adverse effects on fetus