Maternity And Newborn Medication

Front 1

Oxytocin(Pitocin)

Back 1

stimulates the smooth muscles of the uterus.
induces contractions.
IV, IM, intranasal

Front 2

oxytocin (pitocin)-uses

Back 2

1.induce labor
2.control postpartum bleeding
3. promote milk let down and facilitate breastfeeding(intranasal)
4. induce or complete abortion

Front 3

oxytocin(pitocin) adverse reactions and contraindications

Back 3

1. may include allergies, dysrhytmias, changes in BP, uterine rupture, water intoxication.
2. may produce uterine hypertonicity that results in fetal and maternal injury.
3. high doses can cause HYPOtension, rebound HYPERtension
4.postpartum hemorrhage can occur bc the uterus can become atonic.
5. should not be used w a client who cannot deliver vaginally, or one with hypertonic uterine contractions

Front 4

oxytocin (pitocin) interventions

Back 4

1.Mon. maternal VS q 15min.
2. Mon contractions(frequency, duration, force, resting uteine tone q 15min)
3. Mon. fetal HR q 15 mins.
4. ADM IV infusion via an infusion (Y setup or stopcock is used with NS in the primary line)
5. DO NOT LEAVE THE CLIENT UNATTENDED WHILE IV IS INFUSING
6. Notify RN if uterine hyperstimulation or nonreassuring FHR occurs,infusion stopped, the client is turned on her side.IV rate of NS will be increased.

Front 5

Ergot Alkaloids

Back 5

directly stimulate uterine muscle, increase force and greq. of contractions. produce a firm tetanic contraction of the uterus.
2. can produce arterial vasoconstriction and vasospasm of the coronary arteries.
3. not administered before the delivery of the placenta.

Front 6

ergot alkaloids- uses

Back 6

1.postpartum hemorrhage
2. postabortal hemorrhage resulting from atony or involution

Front 7

ergot alkaloids- adverse reactions and contraindications

Back 7

1.can cause nausea, uterine cramping, bradycardia, dysrhythmias, MI, and severe hypertension
2. high doses; peripheral vasospasm, vasoconstriction, angina, miosis, confusion, resp. depression, seizures, unconsciousness, uterine tetany.
3. CI during pregnancy, cardiovascular disease, peripheral vascular disease, HYPERtenstion

Front 8

ergot alkaloids interventions

Back 8

1. produces vasoconstriction, if rise in BP, hold med, notify RN.
2. mon uterine contractions for frequency, strength, duration
3. assess for chest pain, headache, SOB, itching, pale, cold hands and feet, nausea, diarrhea, dizziness

Front 9

prostaglandin (carbopost tromethamine hemabate)

Back 9

1. contracts uterus
2. postpartum hemorrhage

Front 10

prostaplandin (carbopost tromethamine hemabate)- adverse reactions

Back 10

1. cause headaches, N&V, fever
2. CI if client has asthma

Front 11

prostaglandin (carboprost tromethamine hemabate)- interventions

Back 11

1. check temp q 1-2 hours
2. ausculatate breath sounds frequently

Front 12

Tocolytics- stop preterm labor. Different names)

Back 12

indomethacin
mag sulfate
Nifedipine(procardia, Adalat)
Ritodrine hydrochloride
Terbutaline(Brethine)

Front 13

Magnesium sulfate

Back 13

1. CNS depressant
2. relaxes smooth muscle,including uterus
3. used to halt preterm labor contractions
4. used for preeclamptic clients to prevent seizures.

Front 14

magnesium sulfate- adverse reaction

Back 14

1. depressed resp., depressed deep tendon reflex, hyoptenstion
2. extreme muscle weakness, flushing, decreased urine output, pulmonary edema, serum mag > 9mg/dl

Front 15

magnesium sulfate- nursing interventions

Back 15

1. use controller pump
2. keep calcium gluconate(antidote) by bedside

Front 16

ritodrine

Back 16

adrenergic agonist
relaxes smooth muscle, inhibiting uterine and causing bronchodilation

Front 17

ritodrine- adverse reactions

Back 17

1. sob, coughing, tachypnea, pulmonary edema
2. tachycardia, palpitations, chest pain, hypotension
3. fluid retention and decreased urine production
4. tremors, dizziness, muscle cramps, weakness
5. headache
HYPOkalemia, HYPERglycemia, HYPOcalcemia

Front 18

ritodrine- nursing intervention

Back 18

1. disc. infusion if maternal HR >120-140 b/m, dysrhythmias, chest pai, BP <90/60, signs of pulmonary edema, FHR >10 b/m
2. ensure that Beta-blocking agent such as propranolol(inderal) is available to reverse adverse CV reactions

Front 19

terbutaline(Brethnine)

Back 19

beta-adrenergic agonist
2. relaxes smooth muscles, inhibiting uterine activity and causing bronchodilation

Front 20

terbutaline(Brethine)-adverse reactions

Back 20

similar to ritodrine but limited and less severe

Front 21

terbutaline(Brethine)- nursing interventions

Back 21

1. if adverse reactions, notify the physician if they occur

Front 22

nifedipine(Procardia, Adalat)

Back 22

calcium channel blocker
relaxesd smooth muscles, including the uterus, by blocking calcium entry

Front 23

nifedipine(Procardia, Adalat)- adverse reactions

Back 23

1. transient tachycardia
2. palpitations
3. hypotension
4. dizziness, headache, nervousness
5. facial flushings
6. fatigue, nausea

Front 24

nifedipine (Procardia, Adalat)- nursing interventions

Back 24

avoid use cautiously with mag. sulfate. bc severe hypotension can occur.

Front 25

Indomethacin

Back 25

prostaglandin inhibitor
relaxes uterine smooth muscle

Front 26

indomethacin- adverse reactions

Back 26

maternal N&V, dyspepsia, dizziness
2. fetal, premature closure of ductus arteriosus
3. neonate bronchpulmonary dysplasia, resp. distress syndrome, intracranial pressure, necrotizing entercolitis, and hyperbilirubinemia

Front 27

indomethacin- nursing intervention

Back 27

1. used only when other methods fails, if gestational age is <32 weeks.
2. not used in women with bleeding potential, peptic ulcer disease, or oligohydramnios

Front 28

prostoglandins

Back 28

ripen the cervix thus making it softer and causing it to begin to dilate and efface.
2. Stimulate uterine contractions
3. Admnistered vaginally
4. to induce labor and abortion

Front 29

prostoglandins- contraindications

Back 29

1. active cardiac, hepatic, pulmonary, or renal disease.
2. pelvic inflammatory disease
3. client for whom vaginal delivery is not indicated.
4. history of c-section, major uterine surgery
5. history of difficult labor
6.significant cephalopelvic disproportion

Front 30

prostaglandin- adverse reaction

Back 30

1. significant GI s/e
2. fever, chills, flushing, headache, HYPOtension
3. fetal passage of meconium

Front 31

prostaglandin- interventions

Back 31

1. have client void b4 adm. of medication. Have her maintain a supine with a lateral tilt, or side lying position for 30-40 minutes after adm.

Front 32

opoid analgesics

Back 32

used to relieve moderate to severe pain associated with labor
2. ADM. IM, IV
2. regular use od opiods during pregnancy may produce withdrawal symptoms in the neonate(irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing and seizures)

Front 33

what is the antidote for opioids?

Back 33

Naloxone(Narcan)

Front 34

Meperidine hydrochloride(Demoral)- AR and CI

Back 34

1.may be prescribed with promethazine(phenergan) to prevent nausea.
2. high doses; resp. depression, skeletal muscle flaccidity, cold clammy skin, cyanosis, stupor, coma
3.not adm. in early labor, slows labor process
4. not adm. in advanced labor , may cause neonate resp depression

Front 35

types of opioids

Back 35

Meperidine hydrochloride(Demerol)
2.Morphine sulfate, fentanyl(Sublimaze)
3. Butorphanol tartrate(studol)
4.Nalbuphine(nubain)

Front 36

morphinr sulfate, fentanyl(Sublimaze)

Back 36

can cause resp. depression, fetal narcosis/distress, hypotension, urinary retention

Front 37

butorphanol tartrate(stadol), nalbuphine(Nubain)

Back 37

1. cause less resp. depression than the agonists(morphine)
2. use cautiously with client with pre existing opioid dependency, bc withdrawal symp. occur immediately

Front 38

opioid analgesic- intervention

Back 38

1.obtain a drug history b4 adm.
2. mon VS esp resp.
3. mon HYPOtension, notify RN
4. have antidote naloxone(Narcan)

Front 39

Betamethasone

Back 39

a coritcosteroid that increases the production of surfactant.
2. use for client in preterm labor 28-32 weeks, whose labor can be inhibited for 48 hours w/o jeopardizing mother and fetus

Front 40

Betamethasone- adverse reactions and contraindications

Back 40

1. may decrease mother resistance to infection
2. pulmonary edema secondary to sodium and fluid retention
3. elevated blood glucose levels in client w diabetes mellitus

Front 41

lung surfactant types of meds

Back 41

Beractant(survanta)
Colfosceril palmitate(exosurf)

Front 42

lung surfactant

Back 42

1. replenish surfactant to restore surface activity to the lungs
2. Intratracheal route
3. prevent or treat resp. distress syndrome in premature infants

Front 43

lung surfactant-adverse reactions and contraindications

Back 43

1. include transient bradycardia and oxygen desaturation
2. adm. with caution to those at risk for circulatory overload.

Front 44

lung surfactant-interventions

Back 44

1. surfactant is instilled through a catheter inserted in infants endotracheal tube
2. avoid suctioning for 2 hours after adm.
3. mon for bradycardia, decreased o2 saturation
3. assess lungs for crackles and moist breath sounds

Front 45

RHo(D) immune globulin (RHOGAM)

Back 45

prevent anti RHo(D)antibody formation.
2. Most successful is adm. 28 weeks gestation and within 72 hours after delivery
2. to prevent isoimmunization in Rh negative clients who are exposed or potentially to Rh positive RBCs
NOT ADM TO NEWBORNS

Front 46

types of eye prophylaxis

Back 46

1. erythromycin(0.5% ilotycin)
2. tetracycline(1%)
3. Silver nitrate (1%)

Front 47

erythromycin (0.5% Ilotycin) and Tetracycline(1%)

Back 47

1. opthalmic ointment or drops
2. Provide prophylaxis against infection Neisseria gonorrhoe and chlamydia trachomatis.
3.

Front 48

Silver nitrate(1%)

Back 48

1. use is minimal bc it does not protect against chlamydial infection and can cause chemical conjuctivitis
2. preventitive treatment of gonorrhea is required by law

Front 49

eye prophylaxis- adverse reactions and interventions

Back 49

1. silver nitrate (1%) can cause conjuctivitis.
2. cleanse neonate eyes before installing drops or ointment
3. instill in each of the neonate conjuctival sacs within 1 hour after delivery
4. do not flush eyes after instillation

Front 50

Vitamin K (aquamephyton)

Back 50

1. aiding in production of active prothrombin
2. newborns are deficient in vit. k the first 5-8 days bc lack of intestinal flora necessary to absord vit. k.
3. use for prophylaxis and treat hemorrhage in neonate

Front 51

vitamin K (Aquamephyton)

Back 51

1. can cause hyperbilirubinemia in newborns
2. protect medication from light
3. adm in vastus lateralis muscle of the thigh
3. mon for bruising at inj. site and bleeding from cord.
4.monitor for jaundice

Front 52

Rubella vaccine

Back 52

1. give if rubella titer is less than 1:8
2. given subcutaneously before hospital discharge to nonimmune postpartum clients

Front 53

Rubella vaccine- AR and intervention

Back 53

AR; transient rash and hypersensitivity
Interventions;
1. DO NOT give if client or family member are immunocompromised
2. Take contraception- client should avoid pregnancy 1-3 months

Front 54

Hep B vaccine

Back 54

given IM to mewborns b4 discharge.
2. recommended for all newborns to prevent hep B.

Front 55

Hep B Vaccine- AR and interventions

Back 55

AR; rash, fever, erythema, pain at injection site.
Interventions
1. parental consent must be obtained
2. adm. 3rd vastus lateralis IM
2. if mother is pos. for Hep B., hep b immune globulin should be given within 12 hours in addition to vaccine.