Nclex Ch 26: Maternity And Newborn Medications

Front 1

Meds Used to Manage Postpartum Bleeding

Back 1

-Oxytocin (Pitocin)
-Ergot alkaloids: Ergotrate, Ergometrine, Methergine
-ProstaglandinF2: carboprost tromethamine, Hemabate

Front 2

Oxytocic Medications: Oxytocin (Pitocin)
-Description
-Uses

Back 2

-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

Front 3

Oxytocic Medications: Oxytocin (Pitocin)
-Adverse Reactions
-Interventions

Back 3

-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

Front 4

Ergot Alkaloids

Back 4

-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

Front 5

Prostaglandin F2

Back 5

-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

Front 6

Medications to Stop Preterm Labor Contractions

Back 6

-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

Front 7

Magnesium Sulfate
-Class
-Adverse Reactions

Back 7

-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

Front 8

Magnesium Sulfate
-Interventions

Back 8

-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

Front 9

Ritodrine
-Class
-Adverse Reactions

Back 9

-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

Front 10

Ritodrine
-Interventions

Back 10

-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

Front 11

Terbutaline (Brethine)
-Class
-Adverse Reactions

Back 11

-ß-adrenergic agonist; relaxes smooth muscle causes bronchodilation
-Similar to ritodrine but limited and less severe

Front 12

Nifedipine (Procardia, Adalat)
-Class
-Adverse Reactions
-Interventions

Back 12

-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

Front 13

Indomethaicn
-Class
-Adverse Reactions
-Interventions

Back 13

-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

Front 14

Prostaglandins

Back 14

-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

Front 15

Contraindications of Prostaglandin Use

Back 15

-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

Front 16

Opioid Analgesics

Back 16

-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)

Front 17

Betamethasone

Back 17

-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

Front 18

Lung Surfactants

Back 18

-Beractant (Survanta)
-Colfosceril palmitate (Exosurf)

Front 19

Lung Surfactant Therapy

Back 19

-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

Front 20

RH0(D) Immune Globulin (RHOGAM)

Back 20

-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
-

Front 21

Eye Prophylaxis for Neonate

Back 21

-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

Front 22

Vitamin K (Aquamephyton)

Back 22

-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

Front 23

Rubella Vaccine

Back 23

-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

Front 24

Hep B Vaccine

Back 24

-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