Maternity and Newborn Medications - Saunders

Oxytocin Adverse Effects/Contraindications

- Allergies, dysrhythmias, changes in blood pressure, uterine rupture, and water intoxication - May produce uterine hypertonicity, resulting in fetal or maternal adverse effects - High doses may cause hypotension, with rebound hypertension - Postpartum hemorrhage can occur and should be monitored for, because the uterus may become atonic when the medication wears off - should not be used in a client who cannot deliver vaginally or in a client with hypertonic uterine contractions; it is also contraindicated in a client with active genital herpes

Contraceptives side/adverse effects

- Breakthrough bleeding - excessive cervical mucus formation - breast tenderness - HTN - N/V

Opioid Hydromorphone hydrochloride

- Can cause dizziness, nausea, vomiting, sedation, low BP, Low RR, diaphoresis, flushed face, and urinary retention - May be prescribed with an antiemetic such as promethazine to prevent nausea - High doses = respiratory depression, skeletal muscle flaccidity, could clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor and coma - Used cautiously in moms with preterm newborns - Not administered in advanced labor (once transition phase during stage 1 of labor has been reached) if the medication is not adequately removed from fetal circulation respiratory depression can occur.

Ergot alkaloid adverse effects

- Can cause nausea, uterine cramping, bradycardia, dysrhythmias, myocardia infarction, severe hypertension - High doses are associated with peripheral vasospasm or vasoconstriction, angina, miosis, confusion, respiratory depression, seizures, or unconsciousness; uterine tetany can occur - Contraindicated during pregnancy and in clients with significant cardiovascular disease, peripheral vascular disease or hypertension.

Fertility Medications

- Chorionic gonadotropin - Clomiphene Citrate - Follitropin alfa - Follitropin Beta - Menotropins - Urofollitropin - Cetrorelix - Ganirelix

Ergot Alkaloid (methylergonovine maleate) description

- Directly stimulates uterine muscle, increases the force and frequency of contractions, and produces a firm tetanic contraction of the uterus - Can produce arterial vasoconstriction and vasospasm of the coronary arteries - An ergot alkaloid is administered postpartum an is not administered before the birth of the placenta

Rh Immune Globulin Adverse Effects/Contraindications

- Elevated temperature - Tenderness at the injection site - Contraindicated for Rh-positive clients - Contraindicated in clients with a history of systemic allergic reactions to preparations containing human immunoglobulins Not administered to the newborn

Fertility Medications Description

- Fertility medications act to stimulate follicle development and ovulation in functioning ovaries and are combined with human chorionic gonadotropin to maintain the follicles once ovulation has occurred. - Contraindicated in the presence of primary ovarian dysfunction, thyroid or adrenal dysfunction, ovarian cysts, pregnancy, or idiopathic uterine bleeding. - Cautious use in clients with thromboembolic or respiratory disease

Prostaglandin Adverse effects

- Gastrointestinal effects, including diarrhea, nausea, vomiting, and stomach cramps - Fever, chills, flushing, headache, and hypotension - Uterine tachysystole (> or equal to 12 uterine contraction in 20 minutes without an alteration in the fetal heart rate pattern) - Hyperstimulation of the uterus - Fetal passage of meconium

Fertility Medications Nursing interventions

- Instruct the Client regarding administration of the medication - Provide a calendar of treatment days and instructions on when intercourse should occur to increase therapeutic effectiveness of the medication - Provide information about the risks and hazards of multiple births - Instruct the client to notify the OB if signs of ovarian overstimulation occur - Inform the client about the need for regular follow-up for evaluation.

Medications to manage PPH

- Methylergonovine (ergot alkaloid) - Oxytocin (hormone) - Prostaglandin F2a: Carboprost tromethamine

Magnesium sulfate Interventions

- Monitor Maternal VS (Especially RR) q 30-60min - Assess Renal function and electrocardiogram for cardiac function - Monitor Ma lvls q6h or if s/s of toxicity are noted (or if therapeutic range is exceeded) - Only administer by IV infusion via infusion device - Keep calcium gluconate available (antagonizes the effects of magnesium sulfate) - Monitor DTR q1h, for s/s of toxicity - Test patellar reflex before administering a repeat parenteral dose (suppressed reflex may be a sign of impending respiratory arrest) - Patellar reflex must be present and RR must be > 12 b/min before parenteral dose - Monitor I/O's hourly ( 25-30 mL/hr) the medication is eliminated through the kidneys

Oxytocin Nursing Interventions

- Monitor Maternal vital signs (q15min) esp. the blood pressure and HR, weight, I/O's, LOC, and lung sounds - Monitor frequency, duration, and force of contractions and resting uterine tone every 15 min - Monitor FHR q15min, and notify the OB if significant changes occur; use of an internal fetal scalp electrode may be prescribed - Administered by IV infusion via monitoring device (MOST COMMON); prescribed additive solution is piggybacked at the port nearest the point of venous insertion (prescribed additive solution may be NS, LR, or D5 in water) - Carefully monitor the dose being administered, do not leave the client unattended while the oxytocin is infusion - Administer oxygen if prescribed - monitor for hypertonic contractions or a non-reassuring FHR and notify the OB if these occur - Stop the med if uterine hyperstimulation or a non-reassuring fetal heart rate occurs, turn the mom on her side, increase the IV rate of the additive solution, and administer oxygen via face mask - Monitor for s/s of water intoxication - have emergency equipment readily accessible - document the dose f the medication and the time the medication was started, increases, maintained, and discontinue; document the clients response - Keep the client and family informed of the progress

Contraceptives Nursing Interventions

- Monitor VS and weight - Instruct the client in the administration of the med (may take up to 1 week for full effect to occur) - Instruct someone with DM to monitor glucose levels carefully - Instruct them to report signs of thromboembolic complications - Instruct to notify the OB if vaginal bleeding or menstrual irregularities occur or if pregnancy is suspected - Advise them to use an alternative method of birth control when taking antibiotics - instruct to perform breast self exam regularly and about the importance of annual physical exams

Prostaglandin Nursing Interventions

- Monitor maternal vital signs, FHR pattern, status of pregnancy, including indications for cervical ripening or the induction of labor, contraindications, adverse effects, signs of labor or impending labor, and the Bishop score - Have the client void before administration of medication and then have her maintain a supine with lateral tilt or side-lying position for 30-60 min (gel) up to 2 hrs (insert) after administration, depending on the medication administered. - Treatment is discontinued when the Bishop score is 8 or more (cervix ripens) or an effective contraction pattern is established (3 or more contractions in a 10 min period); in addition, signs of adverse effects indicate that the treatment needs to be discontinued - Follow protocol for induction of labor if cervical ripening has occurred and labor has not begun. (oxytocin may be initiated if needed 6-12 hrs after discontinuation of prostaglandin therapy)

Ergot alkaloid Nursing Interventions

- Monitor maternal vital signs, weight, I/O's, LOC, and lung sounds (similar to Oxytocin) - Monitor BP closely; medication produces vasoconstriction, and if an increase in BP is noted, withhold medication and notify the OB - Monitor uterine contractions (F/S/D) - Assess for chest pain, headache, SOB, itching, pale/cold skin, N/D, dizziness - Assess the extremities for color, warmth, movement, and pain - assess for vaginal bleeding - Notify the OB if chest pain or other adverse effects occur - administer analgesics as prescribed; they may be required because the medication produces painful uterine contractions.

Tocolytics: Interventions

- Position mom on her side (left) to enhance placental perfusion and reduce pressure on the cervix - Monitor maternal vital signs, fetal status, and labor status frequently according to agency protocol - Monitor for s/s of adverse effects to the meds - Monitor daily weight and input/output, provide fluid intake as prescribed - Offer comfort measures and provide psychosocial support to patient and family - Reference Nursing interventions for specific medications

Prostaglandin uses

- Preinduction cervical ripening (ripening of the cervix before before the induction of labor when the Bishop score is < or equal to 4) - Induction of labor - Induction of abortion (abortifacient agent)

Rh immune globulin (RhoGAM)

- Prevention of anti-rh (D) antibody formation is most successful if the medication is administered twice, at 28 weeks and again within 72 hrs after delivery - Should be administered within 72 hrs after potential or actual exposure to Rh-positive blood and must be given with each subsequent exposure or potential exposure to rh-positive blood

Phytonadione Nursing Interventions

- Protect the medication from light - Administer during the early newborn period - Administer by the IM route in the lateral aspect of the middle third of the vastus lateralis muscle of the thigh - Monitor for bruising at the injection site and for bleeding from the cord - Monitor for jaundice and monitor the bilirubin level because, although rare, the medication can cause hyperbilirubinemia in the newborn.

Prostaglandin Descriptions

- Ripen the cervix, making it softer and causing it to begin dilating and effacing - Stimulates uterine contractions - Administered Vaginally

Fertility Medications Side/Adverse Effects

- Risk of multiple births and birth defects - Ovarian overstimulation (Abdominal pain, distention, ascites, pleural effusion) - Headache, irritability - Fluid retention and bloating - N/V - Uterine Bleeding - Ovarian enlargement - Gynecomastia - Rash - Orthostatic Hypotension - Febrile reactions

Phytonadione (Vitamin K) Description/use

- The Newborn is at risk for hemorrhagic disorders; coagulation factors synthesized in the liver depend on phytonadione (Vit K), which is not synthesized until intestinal bacteria are present - Newborns are deficient in phytonadione for the first 5-8 days of life because of the lack of intestinal bacteria - Prophylaxis and treatment of hemorrhagic disease of the newborn

Rubella Vaccine Adverse Effects/Contraindicated

- Transient rash, hypersensitivity - Contraindicated in people allergic/sensitive to eggs Check with OB regarding administration

Oxytocin Uses

- induces or augments labor - controls postpartum bleeding - manages an incomplete abortion

Contraceptives description

- meds contain a combo of estrogen and a progestin or a progestin alone and come in several different forms (oral, IM, and Implants) - Estrogen-progestin combos suppress ovulation and change the cervical mucus, making it difficult for sperm to enter - Progestin only meds are less effective - Usually Contraceptives are taken for 21 consecutive days and stopped for 7 days then it is repeated. - Provide reversible prevention of pregnancy - Contraceptives are useful in controlling irregular or excessive menstrual cycles - risk factors associated with the development of complications related to the use of contraceptives include smoking, obesity, and HTN. - Contraindicated in women with HTN, thromboembolic disease, cerebrovascular or coronary artery disease, estrogen-dependent cancers, and pregnancy - Should be avoided with use of hepatotoxic medications - interfere with the activity of bromocriptine mesylate and anticoagulants and increase the toxicity of tricyclic antidepressants. - may alter blood glucose levels - Antibiotics may decrease the absorption and effectiveness of oral contraceptives

Ergot alkaloid uses

- postpartum hemorrhage - Postabortal hemorrhage resulting from atony (failure to contract) or involution (return of the uterus to a non-pregnant state)

Eye prophylaxis for the Newborn Description/use

- preventive eye treatment against ophthalmia neonatorum in the newborn is REQUIRED BY LAW in the United States - Ophthalmic forms of erythromycin are prescribed because it is bacteriostatic and bactericidal and provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis. - as a prophylactic measure to protect against N. Gonorrhoeae and C. trachomatis

Rh immune Globulin Use

- to prevent isoimmunization in Rh-negative clients who are negative for rh antibodies and exposed or potentially exposed to rh-positive red blood cells by amniocentesis, chorionic villus sampling, transfusion, terminations or pregnancy, abdominal trauma, or bleeding during pregnancy or the birth process

Bishop Score Station of presenting part

0 - -3 1 - -2 2 - -1 3 - +1 or +2

Bishop Score Effacement of Cervix

0 - 0-30% 1 - 40-50% 2 - 60-70% 3 - >80%

Bishop Score Dilation of Cervis

0 - 0cm 1 - 1-2cm 2 - 3-4cm 3 - >5cm

Bishop Score Consistency of Cervix

0 - Firm 1 - Medium 2 - Soft 3 - -----

The nurse asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed? 1. "I will flush the eyes after instilling the ointment" 2. "I will clean the newborn's eyes before instilling ointment" 3. "I need to administer the eye ointment within 1 hours after delivery" 4. "I will instill the eye ointment into each of the newborn's conjunctival sacs."

Ans: 1 Rationale: eye prophylaxis protects the newborn against Neisseria gonorrhoeae and Chlamydia trachomatis. The eyes are not flushed after instillation of the medication because the flush would wash away the administered medication. Options 2,3 and 4 are correct statements.

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? SATA 1. Flushing 2. Hypertension 3. Increased urine output 4. Depressed respirations 5. Extreme muscle weakness 6. Hyperactive deep tendon reflexes

Ans: 1,4,5 Rationale: Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus, it is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed RR, depressed DTR, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate & contractions have stopped. If the client's labor can be inhibited for the next 48 hours, what medication does the nurse anticipate will be prescribed? 1. Nalbuphine 2. Betamethasone 3. Rh (D) immune globulin 4. Dinoprostone vaginal insert

Ans: 2 Rationale: Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine is an opioid analgesic. Rh Immune globulin is given to Rh-negative clients to prevent sensitization. Dinoprostone vagina insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment. 1. Uterine tone 2. Blood pressure 3. Amount of lochia 4. Deep tendon reflexes

Ans: 2 Rationale: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The OB needs to be notified if hypertension is present. Although options 1,3, and 4 may be components of the postpartum assessment, blood pressure is related specifically to the administration of this medication.

The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Subcutaneous 4. Intramuscular

Ans: 2 Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1,3, and 4 are not routes of administration for this medication

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? SATA 1. Proteinuria of 3+ 2. Respirations of 10 breaths/min 3. Presence of DTR 4. Urine output of 20 ml in 1 hr 5. Serum magnesium of 4 mEq/L (2mmol/L)

Ans: 2, 4 Rationale: Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of DTR, and a sudden decline in FHR and maternal HR and BP. RR lower than 12 Breaths/min is a sign of toxicity. Urine output should be at least 25-30 mL/hr. Proteinuria of 3+ is an expected finding in a patient with preeclampsia. Presence of DTR is a normal and expected finding. Therapeutic serum magnesium levels are 4-7.5 mEq/L (2-3.75 mmol/L)

The Nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion? SATA 1. Fatigue 2. Drowsiness 3. Uterine Hyperstimulation 4. Late Decelerations of the FHR 5. Early Decelerations of the FHR

Ans: 3, 4 Rationale: Oxytocin stimulates uterine contractions and is a pharmacological method to induce labor. Late decelerations, a nonreassuring FHR pattern, is an ominous sign indicating fetal distress. Oxytocin infusion must be stopped with any signs of uterine hyperstimulation, late decelerations, or other adverse effects occur. Some obstetricians prescribe the administration of oxytocin in 10 min pulsed infusions rather than as a continuous infusion. This pulsed method, which is more like endogenous secretion of oxytocin, is reported to be effective for labor induction and requires significantly less oxytocin use. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the FHR are a reassuring sign and do not indicate fetal distress.

Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact the obstetrician who prescribed the medication if which condition is documented in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease

Ans: 4 Rationale: Methylergonovine is an ergot alkaloid used to treat PPH. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1,2, and 3 are not contraindications related to the use of ergot alkaloids.

Rh (D) immune globulin is prescribed for a client after delivery, and the nurse provides information to the client about the purpose of the mediation. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 1. Having Rh-positive blood 2. Developing a rubella infection 3. Developing physiological jaundice 4. Being affected by Rh incompatibility

Ans: 4 Rationale: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the fetus's Rh-positive blood can enter the maternal circulation, causing the mother's immune system to form antibodies against Rh-positive blood. Administration of Rh immune globulin prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

Eye Prophylaxis for the Newborn Interventions

Clean the newborn's eyes before instilling the medication Do not flush the eyes after instillation Instillation can be delayed for 1 hour after birth to facilitate eye contact and parent newborn attachment and bonding.

Discontinuing Contraceptives

If the intent is to become pregnant the Client should be advised to use an alternative form of birth control for 2 months after To ensure more complete excretion of hormonal agents before conception.

Magnesium sulfate adverse effects/Nursing interventions

Maternal - depressed respiration, depressed DTRs, hypotension, extreme muscle weakness, flushing, decreased urine output, pulmonary edema, serum magnesium levels high (>7.5mEq/L or 3.75mmol/L) Baby - hypotonia and sleepiness Nurse: Discont. and notify OB if adverse effects occur, Monitor for RR < 12, urine output <100ml/4hr (25-30ml/hr), Monitor DTRs, Monitor Ma lvls and report values outside therapeutic range of 4-7.5 mEq/L or 2-3.75mmol/L

Terbutaline Adverse effects/Nursing interventions

Maternal - pulmonary edema, hypotension, hyperglycemia, and tachycardia Baby - tachycardia Nurse: Administered by injection under the skin, Dosing should stop after 48 hrs and should be interrupted if the maternal heart rate exceeds 120 bpm.

Nifedipine adverse effects/nursing interventions

Maternal - tachycardia, hypotension, dizziness, headache, nervousness, facial flushing, fatigue, Nausea Baby - may cause vascular dilation Nurse: Dont use with magnesium sulfate = severe hypotension can occur, monitor for adverse effects

Opioid Butorphanol tartrate and nalbuphine

May be prescribed depending on OB preference - Can cause confusion, sedation, sweating, nausea, vomiting, hypotension, and sinusoidal-like fetal heart rhythm - Use cautiously in moms with preexisting opioid dependence, these meds can precipitate withdrawal symptoms in the mom and baby.

Prostaglandin F2 alpha Interventions

Monitor vital signs Monitor vaginal bleeding and uterine tone

Lung Surfactants Description/Use

Replenish surfactant and restore surface activity to the lungs to prevent and treat respiratory distress syndrome To prevent or treat respiratory distress syndrome in premature babies Administered to the newborn through intratracheal route

Nifedipine Typical use

may be the first-line agent to halt preterm labor contractions

tocolytics maternal contraindications

severe preeclampsia and eclampsia active vaginal bleeding intrauterine infection cardiac disease placental abruption poorly controlled diabetes

Lung Surfactant Nursing Interventions

- Instill surfactant through the catheter inserted into the newborn's endotracheal tube; avoid suctioning for at least 2 hours after administration - Monitor for bradycardia and decreased oxygen saturation during administration - Monitor for respiratory status and lung sounds and for signs of adverse effects

Contraceptive implants

Implants and depot injections provide long-acting forms of birth control, from 3 months to 5 years in duration

Assessing DTR response (0-4)

0 - No response 1 - Sluggish or diminished 2 - Active or expected 3 - More brisk than expected, slightly hyperactive 4 - Brisk, hyperactive, with intermittent or transient clonus

Bishop score: Position of cervix

0 - Posterior 1 - Midposition 2 - Anterior 3 - ------

Hep B Vaccine, Recombinant

- Given IM to the newborn before discharge home - Recommended for all newborns to prevent Heb B

Betamethasone and dexamethasone

* Corticosteroids that increase the production of surfactant to accelerate fetal lung maturity & reduce the incidence or severity of RDS. ADMINISTERED BY DEEP IM

Betamethasone and Dexamethasone Uses

* Used for a client in preterm labor between 28-32 weeks' gestation whose labor can be inhibited for 48 hrs without jeopardizing the mother or fetus.

Contraceptive Vaginal Ring (Nuvaring)

- Inserted into the vagina, left in place for 3 weeks, and removed for 1 week - Medication is absorbed through the mucous membrane of the vagina - Removed rings should be wrapped in a foil pouch and discarded, NEVER FLUSHED

prostaglandin contraindications

- Active cardiac, hepatic, pulmonary, or kidney disease - Acute pelvic inflammatory disease - Clients in whom vaginal delivery is not indicated - fetal malpresentation - history of cesarean section or major uterine surgery - history of difficult labor or traumatic labor - hypersensitivity to prostaglandins - Maternal fever or infection - Nonreassuring fetal heart rate pattern - Placenta previa or unexplained vaginal bleeding - Regular progressive uterine contractions - significant cephalopelvic disproportions `

Rh Immune Globulin Nursing Interventions

- Administer to the client by intramuscular injection at 28 weeks and within 72 hrs after delivery - NEVER administered IV (ONLY IM) arm or butt - Monitor for temperature elevation - Monitor injection site for tenderness This will do nothing if the client already has antibodies to the Rh antigen

Rubella Vaccine

- Administered subQ before hospital discharge to a nonimmune postpartum client - Administered if the rubella titer is less than 1:8

Rubella Vaccine Nursing Interventions

- Assess for allergy to duck eggs and notify the OB before administration if an allergy exists - Question administration if the client or other family members are immunocompromised Patient needs to use a contraceptive/ avoid pregnancy for 1-3 months after vaccine

Oxytocin

- Stimulates the smooth muscle of the uterus and increases the force, frequency and duration of uterine contractions - promotes milk letdown - For induction of labor, oxytocin is administered by the IV route (other route of administration is IM) If injecting intramuscularly, aspiration is necessary to avid injection into a blood vessel - Magnesium sulfate should be available in case relaxation of the myometrium is necessary - Minimal cervical change usually is noted until the active phase of labor is achieved`.

Lung surfactant Adverse effects/contraindications

- Transient bradycardia and oxygen desaturation; pulmonary hemorrhage, mucus plugging, and endotracheal tube reflux can also occur - surfactants are administered with caution in newborns at risk for circulatory overload

Betamethasone and Dexamethasone Adverse Effects

ADVERSE REACTIONS: * May decrease the mother's resistance to infection. * Pulmonary edema secondary to Na+ & fluid retention can occur. * Elevated blood glucose levels can occur in a client with diabetes mellitus.

An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? 1. Naloxone 2. Morphine Sulfate 3. Betamethasone 4. Hydromorphone hydrochloride

Ans: 1 Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine Sulfate and hydromorphone hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.

Magnesium Sulfate

Central nervous system depressant and antiseizure medication Causes smooth muscle relaxation

Prostaglandin F2 alpha Adverse effects

Can cause headache, N/V/D, Fever, tachycardia, and HTN Contraindicated in clients with asthma

phytonadione adverse effects

Can cause hyperbilirubinemia in the newborn (RARE)

Opioid Fentanyl and sufentanil

Can cause respiratory depression, dizziness, drowsiness, hypotension, urinary retention, and fetal narcosis and distress; Sufentanil is used less than fentanyl

Magnesium sulfate adverse effects/contraindications

Continuous IV infusion increases the risk of magnesium toxicity in the newborn Magnesium sulfate is stopped for delivery only if the mom is having a C-section Magnesium sulfate may be prescribed for the first 12-24hrs postpartum if it is used for preeclampsia High doses can cause loss of DTR, Heart block, Respiratory paralysis, and cardiac arrest Contraindicated in patients with Heart block, Myocardial damage, or kidney failure. Medication is used cautiously in patients with kidney impairment.

Prostaglandin F2 alpha (carboprost tromethamine)

Contracts the uterus Used for postpartum hemorrhage

Tocolytics Description/Uses/Examples

Description: produce uterine relaxation and suppress uterine activity Uses: halt uterine contractions and prevent preterm birth Examples: Dihydropyridine calcium channel blockers (nifedipine and magnesium sulfate) and Terbutaline

Factors of the Bishop Score

Dilation of cervix (cm) Effacement of cervix (%) Consistency of cervix Position of cervix Station of presenting part

Oxytocin Priority Nursing Actions

For Hypertonic contractions or a Non-reassuring FHR during Oxytocin infusion - Stop the infusion - turn the client on her side, stay with the client, ask another nurse to contact the OB - Increase the flow rate of the IV Additive - Administer oxygen, 8-10 L/min, by snug face mask. - Assess maternal vital signs, FHR and patterns, frequency, duration, and force of contractions - Document the event, actions taken, and the response

tocolytics fetal contraindications

Gestational age greater than 37 weeks cervical dilation greater than 4 cm fetal demise lethal fetal anomaly chorioamnionitis acute fetal distress chronic intrauterine growth restriction

Betamethasone and Dexamethasone Nursing Interventions

INTERVENTIONS: * Monitor maternal vital signs, lung sounds, & for edema. * Monitor mother for signs of infection. * Monitor WBC. * Monitor blood glucose levels. Administered by deep IM

Opioid Nursing Interventions

Monitor vital signs, particularly respiratory status; if RR are 12 or less, withhold the medication and contact the OB - Monitor FHR and characteristics of uterine contractions - Monitor for blood pressure changes (hypotension), maintain the client in a recumbent position (elevate the hip with a wedge pillow or other device) - Record the level of pain relief - monitor the bladder for distention and retention - have naloxone readily accessible (esp. if delivery is expected to occur during peak medication absorption time)

Hep B Vaccine Nursing Interventions

Parental Consent MUST BE OBTAINED - Administer IM in the lateral aspect of the middle third of the vastus lateralis muscle - if the infant was born to a mother positive for Hep B surface antigen, Hem B immune Globulin should be given within 12 hours of birth in addition to Hep B vaccine. Then follow the regularly scheduled Hep B vaccination schedule - Document immunization administration on a vaccine card so that the parents have a record the vaccine was administered.

Contraceptive Patches

Prevents ovulation - Designed to be worn for 3 weeks and removed for 1 week - Applied on clean, dry, intact, skin on the buttocks, abdomen, upper outer arm, or upper torso - Instruct to peel away half the backing on the patch, apply to the skin, remove the other half, and press down for 10 seconds with the palm - Instruct them to change weakly, using a new location for each patch - If a patch falls off and remains off for less than 24 hrs it can be reapplied if still sticky, or it can be replaced - If the patch is off for more than 24 hours a new 4 week cycle must be started immediately

Prostaglandins Types/administration

Prostaglandin E1: misoprostol intravaginal tablet Prostaglandin E2: dinoprostone vaginal gel, insert, or suppository

Hep B Vaccine Adverse Effects

Rash, fever, erythema, pain at injection site

Magnesium sulfate Uses

Stopping preterm labor to prevent preterm birth, although it is less commonly used for this in practice Preventing and controlling seizures in preeclamptic and eclamptic clients

Uterine Stimulants (Oxytocics)

Three groups of uterine stimulants: 1. Oxytocin (hormone/Pitocin) 2. Ergot alkaloids (Methergine/Methylergonovine) 3. Prostaglandins (dinoprostone/misoprostol)

Opioid Analgesics

Used to relieve moderate to severe pain associated with labor Administered by IM or IV Regular use of opioids during pregnancy may produce withdrawal symptoms in the newborn (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, and seizures) Antidote is naloxone Can cause withdrawal in opioid-dependent clients

Terbutaline Typical use

primarily use to delay birth for several hours to allow the fetus to mature more before birth

Magnesium Sulfate antidote

calcium gluconate