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24 Cards in this Set
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- Back
Meds Used to Manage Postpartum Bleeding
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-Oxytocin (Pitocin)
-Ergot alkaloids: Ergotrate, Ergometrine, Methergine -ProstaglandinF2: carboprost tromethamine, Hemabate |
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Oxytocic Medications: Oxytocin (Pitocin)
-Description -Uses |
-Stimulate the smooth muscle of the uterus and induces the contraction of the myocardium; promotes milk let down; intranasal, IM, and IV; minimal cervical change usually is noted until active phase of labor is achieved
-Induce labor; control postpartum bleeding; facilitate breastfeeding; induce or complete an abortion |
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Oxytocic Medications: Oxytocin (Pitocin)
-Adverse Reactions -Interventions |
-Allergies; dysrhythmias; changes in BP; uterine rupture; intranasal may cause nasal vasoconstriction; uterine hypertonicity; hypotension with rebound HTN; postpartum hemorrhage because uterus may become atonic (w/o tone) when med wears off
-Contradicted in pts who cannot deliver vaginally or with hypertonic uterine contractions -Vitals, FHR and contractions every 15 min; do not leave pt alone while it is infusing; if hyper stimulation or non fetal reassuring FHR occurs, stop infusion, turn pt on side, IV saline increased, and O2 administered; monitor for water intoxication |
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Ergot Alkaloids
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-Directly stimulate uterine muscle, increase force and frequency of contraction and produce a firm tetanic contraction
-Not administered before delivery of the placenta -Uses: postpartum hemorrhage -Adverse reactions: nausea, uterine cramping, bradycardia, dysrhythmias, MI, severe HTN; high doses associated with peripheral vasospasm, angina, confusion, resp depression, seizures, uterine tetany -Contradicted during pregnancy and in pts with PVD -Interventions: I&O, weight, LOC, lung sounds, contractions; withhold med if rise in BP |
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Prostaglandin F2
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-Contracts uterus
-Uses: postpartum Hemorrhage -Adverse reactions: headache, nausea, vomiting and fever -Contradicted in pt with asthma -Interventions: check temp every 1-2 hr; breath sounds frequently |
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Medications to Stop Preterm Labor Contractions
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-Produce uterine relaxation
-Contraindicated in pts with preeclampsia and eclampsia, active vaginal bleeding, intrauterine infection, cardiac disease -Position pt on side to enhance placental perfusion and reduce pressure on cervix -Indomethacin -Magnesium sulfate -Nifedipine: Procardia, Adalat -Ritodrine hydrochloride -Terbutaline: Brethine |
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Magnesium Sulfate
-Class -Adverse Reactions |
-CNS depressant, relax smooth muscle, used to halt preterm labor contractions, used for preeclamptic pts to prevent seizures
-Depressed resp, deep tendon reflex (may be a sign of impending resp arrest), urine output; hypotension, muscle weakness, flushing, pulm edema, magnesium ≥9mg/dL, mag toxicity to neonate |
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Magnesium Sulfate
-Interventions |
-Discontinue if adverse reactions occur
-Monitor for respirations<12 per minute and urine output of <100mL per 4 hours(25-30mL/hr) -Monitor mag levels and report outside normal range (1.5-2.5mg/dL) -IV administration should not be used within 2 hours brocading delivery -Patellar reflex must be present and reps rate must be >16 before each parenteral dose -Antidote: calcium gluconate |
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Ritodrine
-Class -Adverse Reactions |
-ß-adrenergi agonist, relaxes smooth muscle and causes bronchodilation
-SOB, coughing, tachypnea, pulm edema; tachycardia, palpations, angina, hypotension; fluid retention and decreased urine output; tremors, dizziness, muscle cramps and weakness, headache, hypokalemia, hypocalcemia, hyperglycemia |
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Ritodrine
-Interventions |
-Discontinue if maternal heart rate >120, FHR>180, BP<90/60, dysrhythmias, chest pain, s/sx pulm edema
-Ensure that ß-blocking agents such as propranolol (Inderal) is available to reverse adverse cardio reactions |
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Terbutaline (Brethine)
-Class -Adverse Reactions |
-ß-adrenergic agonist; relaxes smooth muscle causes bronchodilation
-Similar to ritodrine but limited and less severe |
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Nifedipine (Procardia, Adalat)
-Class -Adverse Reactions -Interventions |
-Calcium channel blocker; relaxes smooth muscle by blocking calcium entry
-Transient tachycardia, palpations, hypotension, dizziness, headache, nervousness, facial flushing, fatigue, nausea -Avoid use or use cautiously with mag sulfate b/c severe hypotension can occur |
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Indomethaicn
-Class -Adverse Reactions -Interventions |
-Prostaglandin inhibitor, relaxes uterine smooth muscle
-Maternal: nausea, vomiting, dyspnea, dizziness; Fetal: premature closure of ductus arteriosus ; neonate: bronchopulmonary dysplasia, resp distress syndrom, intracranial pressure, hyperbilirubinemia -Used when all other methods fail and if gestational age is <32 weeks; not used in women with bleeding potential, peptic ulcer disease, or oligohydramnios; determine amniotic fluid level and function of ductus arteriosus before administration and within 48 hrs after |
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Prostaglandins
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-Used to ripen cervix (soften and efface), stimulate uterine contractions; induce labor or abortion
-Administered vaginally -Signifigant GI upset (diarrhea, nausea, vomit, stomach cramps) -Fever, chills, flushing, headache, hypotension -Hyperstimulation of the uterus, fetal passage of meconium -Have client void before administration and maintain a supine with lateral tilt or side lie for 30-40 min |
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Contraindications of Prostaglandin Use
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-Active cardiac, hepatic, pulmonary or renal disease
-Acute PID -Clients whom vaginal delivery is not indicated -Malpresentation of fetus -History of cesarean or major uterine surgery, traumatic labor -Maternal fever or infection -placental previa or unexplained vaginal bleeding -Nonreassuring FHR -Regular progressive contractions -Significant cephalopelvic disproportion |
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Opioid Analgesics
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-May cause withdrawal symptoms in neonate
-Not administered in early labor because it may slow the labor process, or within 1 hour of delivery to adequately remove it from fetal circulation -Use with caution with preexisting opioid dependency because withdrawal symptoms can occur immediately -Morphine sulfate, fentanl (Sulimaze) can cause resp depression, fetal narcosis/distress, hypotension and urinary retention -Butorphanol (Stadol), nalbuphine (Nubain) cause less resp depression than morphine -Antidote: Narcan (esp if delivery is going to occur during peak drug absorption) |
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Betamethasone
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-Corticosteroid that increases production of surfactant
-Used for a pt in preterm labor between 28-32 weeks who's labor can be inhibited for 48 hours w/o jeopardizing the mother or fetus -May decrease resistance to infection -Pulm edema secondary to sodium and fluid retention -Elevated blood glucose in a pt with DM |
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Lung Surfactants
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-Beractant (Survanta)
-Colfosceril palmitate (Exosurf) |
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Lung Surfactant Therapy
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-Replenish surfactant and restore surface activity to the lungs; administered endotracheal route (through catheter)
-Px/treat resp distress syndrome in premi infants -Adverse reactions: transient bradycardia, O2 desaturation -Administer with caution to those at risk for circulatory overload -Avoid suctioning for 2 hours |
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RH0(D) Immune Globulin (RHOGAM)
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-Px of anti-Rh0(D) antibody formation in those who are exposed or potentially exposed by blood transfusion, termination of pregnancy amniocentesis, chorionic villus sampling, abdominal trauma, or birthing process
-Contradicted in Rh-positive women -Never administer IV -Most successful if administered at 28 weeks and within 72 hrs after delivery -Should be administered within 72 hrs after potential or actual exposure -Of no benefit if antibody titer is already positive - |
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Eye Prophylaxis for Neonate
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-Erythromycin and tetracycline ointment or drops are bacteriostatic and bactericidal (px against gonorrhea and chlamydia)
-Required by law -Cleanse eyes first, instill within 1 hour of delivery, do not flush eyes |
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Vitamin K (Aquamephyton)
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-Vit K is necessary for aiding in the formation of active prothrombin
-Newborns are deficient in Vit K for the first 5-8 days of life b/c the lack of intestinal flora that are necessary to absorb Vit K -Px and tx of hemorrhagic disease in newborn -Can cause hyperbilirubinemia -Protect med form light -Administer in the vast us laterals muscle of the thighs -Monitor s/sx bleeding -Monitor for jaundice |
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Rubella Vaccine
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-Sub Q before discharge of non immune postpartum pt (if titer is less than 1:8
-Adverse reactions: transient rash -Do not give if immunocompromised -Contraception: avoid pregnancy for 1-3 months |
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Hep B Vaccine
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-Give IM to newborn before discharge
-Recomened for all infants -Adverse reactions: rash, fever, erythema, and pain at injection site -Obtain parental consent - If mother is hep B positive than Hep B immune globulin should be given within 12 hrs of birth in addition to the vaccine |