Transcript Chapter 40

Chapter 40
Drugs Used in Obstetrics
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Chapter 40
MgSO4 = Uterine relaxant aka TOCOLYTIC agent,
used to delay preterm labor, may help inhibit seizure
activity in eclampsia
Calcium Gluconate= antidote for MgS04 OD (hyperMg)
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OB TERMS
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EDC= Estimated date of confinement aka due date
Gravid= “heavy” or preg uterus
Para= # of births(not babies) >20 weeks (dead or alive)
Abortion= Spont/induced loss before age of viability
Fundus= area of uterus above fall tubes
APGAR score= 1 & 5 minutes p. 283 NCLEX
FHT= Fetal heart tone 100-160bpm, apical X 1 minute
• Amnio= Fluid to cushion baby. Amniocentesis (ck for
congenital abnormalities and lung maturity)
• Fetal Fibronectin= test for preterm labor (test)
• PIH= Pregnancy induced HTN includes preeclampsia
(HTN, proteinuria) & Eclampsia (pre+ convulsions)
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OB TERMS
• Lochia= Uterine discharge
 Rubra= Red Day 1-3 post partum
 Serosa= Pink-brown Day 4-10 postpartum
 Alba= White Day 10-14 postpartum
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The Nursing process
• Just to review:
• Assessment (data collection, sub & obj data)
• Planning (identification of actual & potential
problems and the goals) Actual problems are
a priority over potential or “risk for” problems
• Implementation (just do it!)
• Evaluation (did the intervention work?)
 Expected outcome of administration of Tigan?
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Nursing Assessments in Obstetrics
• Prenatal visit (Endo, CD’s, Drugs, ETOH, Smoker,
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Menst Hx, Meds, RhoGam, Preg & birth Hx)
Nutritional history (wt gain/loss herbal products)
Elimination pattern (B&B habits)
Psychosocial/cultural history (family support, income,
need social services? WIC, Medi-cal Welfare)
Medication history (Rx & OTC & herbal, drug use?)
Physical examination (Pap & pelvic, vs (HR expected
to inc 10 bpm), Labs: STD, CBC, Rh factor, CD titers
Assessment during the first, second, and third
trimesters(q month x 6mos, 7 & 8 mos q 2 weeks, then
weekly the last month)
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Obstetric Complications/ actual
or potential/ what to assess
• Infections= temp, wbc
• Hyperemesis gravidarum= severe, persistent emesis
• Miscarriage, placental separation, abortion, = onset,
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volume, character (clots?) & duration of bleeding &
cramps and/or back pains, FHT, vs for shock
Preterm labor= cervical changes & contraction 20+
weeks
Premature rupture of membranes (PROM)= leak of
amniotic fluid from vagina
Gestational diabetes mellitus (GDM)= Ux, FBS, GTT
Pregnancy-induced hypertension (PIH)= B/P,edema, Ux
Amniocentesis may determine fetal lung maturity and
detect fetal disorders such as?
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Termination of Pregnancy/
Induced Abortion
 Before 12 weeks gestation – suction curettage or
dilation and evacuation
 Between 12 and 20 weeks gestation – giving hypertonic
saline solutions (20%) intra-amniotically, or
prostaglandins intra-amniotically, IM or vaginal
suppository
 After 20 weeks gestation – prostaglandin suppository
+/- oxytocin
 Emotional support/ hormonal changes may occur
 RhoGAM= give to Rh negative mom who has Rh
positive baby (Prevents formation of antibodies in mom
which will harm the next Rh positive baby)
 Rubella titer and vaccine, PRN, Do not give with
RhoGAM
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Normal Labor and Delivery Care
• Labor and delivery care
 Status of labor, membranes, fetal heart rate
 Provide pain relief and comfort measures/ Effleurage=
massage technique in Lamaze
• Postpartum care of the newborn
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Airway+= bulb suction
Clamp the umbilical cord= after + resp status
Health status= APGAR 1 min and 5 min
Temperature maintenance= dry & cover head
Eye prophylaxis= Ophthalmic Emycin for STD
Other procedures=Bracelet, check cord 1 vein, 2
arteries, AquaMEPHYTOIN (vit K), PKU, wt, length
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Slide 9
Patient Education
and Health Promotion
• Postpartum care
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Assess fundal height and lochia
Breasts secrete Colostrum 1st 3 days, then milk
Infant voids 6-8 times in 24 hours
1 stool every 24 hours
Daily weight should gain 0.75-1ounce daily
• Teach
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Breastfeeding techniques, as appropriate
Activity and exercise
Nutritional needs
Infant care needs
Follow-up appointments
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Chapter 40
Lesson 40.2
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Slide 11
Objectives
• State the actions, primary uses, nursing
assessments, and monitoring parameters for
uterine stimulants, uterine relaxants,
clomiphene citrate, magnesium sulfate, and
Rho(D) immune globulin
• Compare the effects of uterine stimulants and
uterine relaxants on a pregnant woman’s
uterus
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Slide 12
Objectives (cont’d)
• Describe specific nursing concerns and
appropriate nursing actions when uterine
stimulants are administered for induction of
labor, augmentation of labor, and postpartum
atony and hemorrhage
• Describe specific assessments needed
before and during the use of terbutaline or
magnesium sulfate
• Identify emergency supplies that should be
available during magnesium sulfate therapy
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Slide 13
Objectives (cont’d)
• Cite the effects of adrenergic agents on beta1 and beta-2 receptors, and then identify the
relationship of these actions to the serious
adverse effects when adrenergic agents are
used to inhibit preterm labor
• Identify the action, specific dosage,
administration precautions, and proper timing
of the administration of Rho(D) immune
globulin and rubella vaccine
• Summarize the immediate nursing care
needs of the newborn following delivery
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Drug Class: Uterine Stimulants
• Actions
 Stimulate the uterus to induce labor
• Uses
 Induce or augment labor
 Control postpartum hemorrhage
 Control postsurgical hemorrhage (as in
cesarean birth)
 Induce therapeutic abortion
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Drug Class: Uterine Stimulants
• Drugs: dinoprostone (Prostin E2, Prepidil, Cervidil
• AKA PROSTAGLANDIN E2
• Action
 Cause uterine and GI smooth muscle stimulation, start
and continue cervical ripening at term
• Uses
 Expel uterine contents after fetal death, benign
hydatidiform mole, missed spontaneous miscarriage,
second-trimester abortion
• Common adverse effects
 Nausea, vomiting, diarrhea, fever
• Serious adverse effects
 Orthostatic hypotension
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Drug Class: Uterine Stimulants
• Drug: misoprostol (Cytotec)Remember this
drug? Also used for prevention of ulcers
• Action
 Cause uterine contractions in pregnancy and
abortifacient
• Uses
 Cervical ripening agent, induce labor, treat
serious postpartum hemorrhage
• Common adverse effects
 Nausea, vomiting, diarrhea, fever
• Serious adverse effects
 Orthostatic hypotension
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Drug Class: Uterine Stimulants
(cont’d)
• Drugs: ergonovine (Ergotrate Maleate),
methylergonovine (Methergine)
• Actions
 Directly stimulate uterine contractions
• Uses
 Control bleeding and maintain firmness in
postpartum patients
• Common adverse effects
 Nausea, vomiting, abdominal cramping
• Serious adverse effects
 Hypertension
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Drug Class: Uterine Stimulants
(cont’d)
• Drug: oxytocin (Pitocin) PP hormone
• Action
 Stimulate uterine smooth muscle, blood vessels,
mammary glands
• Uses
 Initiate active labor during third trimester; used
postpartum to control uterine hemorrhage
• Common adverse effects
 Uterine contractions, nausea, vomiting
• Serious adverse effects
 Fetal distress, hypotension, hypertension, water
intoxication, dehydration, postpartum hemorrhage
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Drug Class: Uterine
Relaxants
• Drug: magnesium sulfate
• Action
 Produce anticonvulsant effects and smooth
muscle relaxation, inhibit uterine muscle
contractions
• Uses
 Inhibit preterm labor, control seizure activity
associated with preeclampsia and eclampsia
• Serious adverse effects
 Absence of deep tendon reflexes, confusion,
reduced urine output
 Calcium gluconate used as an antidote for
magnesium toxicity
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Slide 20
Drug Class: Uterine Relaxants
(cont’d)
• Drug: terbutaline sulfate (Brethine) Remember this
drug? Relaxes broncholes and uterus too
• Actions
 Produce relaxation of uterine, bronchial, and vascular
smooth muscles; increase heart rate
• Uses
 Stop premature labor when no underlying pathology
indicates pregnancy be discontinued
• Serious adverse effects
 Tachycardia, palpitations, hypertension, hypotension,
tremors, nervousness, anxiety, restlessness,
headache, dizziness, nausea, vomiting,
hyperglycemia, electrolyte imbalance
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Slide 21
Other Agents
• Drug: clomiphene citrate (Clomid)
• Actions
 Stimulate ovaries to release ova for potential
fertilization
• Uses
 Induce ovulation in women with reduced
estrogen levels
• Common adverse effects
 Nausea, vomiting, diarrhea, constipation, hot
flashes, abdominal cramps
• Serious adverse effects
 Severe abdominal cramps, visual
disturbances, dizziness
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Slide 22
Other Agents (cont’d)
• Drug: Rho(D) immune globulin RhoGAM
• Actions
 Suppress stimulation of active immunity by
Rh-positive foreign blood cells; prevent
Rh hemolytic disease of newborns in
subsequent pregnancies
• Uses
 Prevent Rh immunization of Rh-negative patient
exposed to Rh-positive blood of fetus
• Common adverse effects
 Localized tenderness, fever, arthralgias,
generalized aches, pains
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Other Agents (cont’d)
• Drug: erythromycin ophthalmic ointment
(Ilotycin)
• Actions and uses
 Macrolide antibiotic used prophylactically to
prevent ophthalmia neonatorum; effective
against C. trachomatis
• Common adverse effects
 Mild conjunctivitis
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Slide 24
Other Agents
• Drug: phytonadione AquaMEPHYTOIN/ Vit K
• Actions
 Fat-soluble vitamin K for the production of
blood clotting factors
• Uses
 Administered prophylactically to protect
against hemorrhagic disease of the newborn
• Serious adverse effects
 Bruising, hemorrhage
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