Ch. 19 Oxytocin Drug Guide
recommended dose for induction/augmentation
initial: 0.5-6mU/min increase dose by 1-2mU every 15 to 40 minutes *depends on absence of adverse effects and uterine response*
common mixtures that provide 60mU/mL
15 units + 250 mL solution 30 units + 500 mL solution 60 units + 1000 mL solution
oxytocin has which two properties?
vasoactive antidiuretic
effective labor pattern
contractions: frequency Q 2-3 minutes duration 20-90 seconds intensity 50-80 mmHg (IUPC)
indication
-maintenance of uterine contraction after birth -induction or augmentation -management of inevitable or incomplete abortion
action
-similar to natural hormone -stimulates uterine smooth muscle: increased strength, duration, frequency of uterine contractions
if tachysystole or non reassuring FHR pattern occurs, what must the nurse do?
1. stop infusion 2. increase rate of nonadditive solution 3. position woman laterally 4. admin oxygen 8-10L/min 5. notify physician of adr, nursing intervention, patient response
dose for inevitable/incomplete abortion
dilute 10 units in 500mL infuse 10-20mU/min
dose to control postpartum bleeding
dilute 10-40 units in 1000mL of IV solution IV: begin rate at 20-40mU/min IM: inject 10 units after delivery of placenta
uterine hypertonicity may result in which FHR patterns?
fetal bradycardia tachycardia reduced FHR variability late decelerations
adr
hypertonic uterine activity fetal asphyxia from impaired uterine blood flow uterine rupture abruptio placentae fetal or maternal trauma from rapid birth maternal fluid retention leading to water intoxication hypotension tachycardia cardiac dysrhythmias subarachnoid hemorrhage
contraindications of oxytocin
placenta previa vasa previa nonreassuring FHR abnormal fetal presentation prolapsed umbilical cord presenting part above pelvic inlet previous classic or other fundal uterine incision active genital herpes infection pelvic structural deformities invasive cervical carcinoma
with each dosage increase, the nurse must record
pulse bp RR intake/output *usually every 30-60min*
