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M6 13-005

OB Rotation Meds

Terbutaline: Classification (Iv or SQ) Autonomic nervous system agent; beta adrenergic agonist; smooth muscle relaxant.
Whats Terbutaline used for? Used to stop contractions during tachysystole.
How does Terbutaline work? Acts on beta-2 adrenergic receptors to relax smooth muscle and reduce uterine contractions. ↑ uterine relaxation thereby preventing or abolishing high intrauterine pressure.
Terbutaline is contraindicated with... Hypersensitivity to symptomatic amine, narrow angle glaucoma, DM, HTN, hyperthyroidism, severe cardiac disease.
Watch out for these side effects with Terbutaline... Palpitations, nervousness, tremors, sweating, HA,N/V, insomnia, light-headedness, drowsiness, fatigue, maternal & fetal tachycardia, seizures, muscle cramps, hypotension or hypertension.
Terbutaline may interfere with... (Dx tests) ↑ blood glucose and may free fatty acids.
With Terbutaline, make sure you as a nurse... Assess BP (Report >130). Monitor V/S (mom 7 fetus). Respiratory status. SC injections usually to lateral deltoid. Cool storage and keep from light and no freezing.
Pitocin: Oxytocin Classification (IV) Oxytocic
How is Pitocin used? 1. Induce labor. 2. ↓ Post-partum bleeding. 3. Ocytocin Challenge Test (OCT). 4. Management of incomplete or inevitable abortion.
How does Pitocin work? causes stimulation of uterine smooth muscle.
Pitocin is contraindicated with... Severe PIH, malpresentation, fetal distress or any contraindication to vaginal delivery. Use cautiously with Hx of uterine Sx, grand multiparity & over distended uterus.
Side effects of Pitocin may include... Tetanic contractions, impaired uterine blood flow & severe uterine tonus resulting: fetal hypoxia/anoxia, uterine rupture, cervical and lower uterine lacerations, placental abruption. Pulmonary edema & coma or convulsions. (rare)
Pitocin nursing interventions would be to... 1. Do not IV push. May run blous after placenta delivery. 2. Monitor contractions. 3. Continuous FHT monitoring w/ intrauterine pressure cath. 4. Contractions <2min, >90sec in duration, stronger than 88mmHg, Stop pitocin. Terbutaline counteracts. I
Methergine: Classification (IM) Ergot Alkaloid.
What is Methergine for? Postpartum hemorrhage, uterine atony & sub-involution.
How does Methergine work? Stimulates uterine and vascular smooth muscle causing contraction.
Contraindications of Methergine are... HYPERTENSION, eclampsia, pregnancy.
With Methergine, keep an eye out for these side effects... Hyper or hypotension, N/V, chest pain, dyspnea, headache, hematuria, thrombophlebitis, water intoxication, hallucinations and leg cramps.
Cytotec: Misoprostol Classification (PO, Vaginally, Rectally) Prostaglandin analog
How is Cytotec used? For cervical ripening and induction of labor. Treatment of postpartum hemorrhage d/t uterine atony which has not responded to conventional management.
What is the action of Cytotec? It stimulates uterine smooth muscle contraction & breakdown of collagen bundles in the cervix to ↑ flexibility & dilation in response to contractions.
Using Cytotec may be contraindicated in patients with... Pregnancy w/o an indication for induction, prior uterine scar (ex; prior c/s or uterine Sx). Placenta Previa, acute HSV out break & any other condition that contraindicates vaginal delivery.
Side feects of Cytotec can be... N/V/D, Headache.
Nursing implications of Cytotec would be to... 1. Monitor VS per SOP. 2. Monitor FHR & contraction during labor. Watch close for uterine hyperstimulation. 3. Monitor fundus and vaginal bleeding until stable. 4. Follow CBC until stable. 5. Record estimated blood loss.
Hemabate: Carboprost Tromethamine Classification (IM) Oxytocic
What do we use Hemabate for? Tx of postpartum hemorrhage d/t uterine atony which has not responded to conventional management.
What action does Hemabate perform? Stimulates myometrial contractions.
Contraindications of Hemabate would be... ASTHMA, HTN, SEVERE DIARRHEA, ↑ temperature.
With Hemabate, Nursing Interventions would be... 1. Monitor uterine response & vaginal bleeding until stable. 2. Force fluids in Pt with drug induced fever. 3. Save all expelled tissue for exam (r/o retained placental fragments). 4. Acetaminophen for induced ↑ temp. 5. Lomotil for diarrhea.
Magnesium Sulfate: Classification ( 1. Anti-convulsant. 2. Tocolytic.
How do we use Magnesium Sulfate? 1. Prevent seizures in pre-eclamptic. 2. Supress contractions of premature labor.
The action of Magnesium Sulfate is... 1. Anti-convulsant: MOA unknown. Relaxes muscle. 2. Tocolytic: Suppresses smooth muscle contractility by ↓ acetylcholine release at the myoneural junction.
Magnesium Sulfate contraindications are... Pts w/ myocardial damage or cardiac block. Pts w/ renal impairment. (Mg excreted through kidneys).
Side effects to Magnesium sulfate are... Sweating, ↓ reflexes, muscle weakness, ineffective uterine contraindications in labor. OD may cause RESPIRATORY ↓ or RESPIRATORY ARREST.
Magnesium Sulfate: Nursing implications V/S q 1hr. Deep tendon reflexes. Contraction pattern. UOP. Watch neonates (if given with 24 hrs of delivery).
Bethamethasone: Celestone Soulspan Classification (IM) Steroid (Glucocorticoid)
What is Bethamethasone used for? Accelerates lung maturity and prevents hyaline membrane disease in the premature infant.
How does Bethamethasone work? Stimulates release of stored surfactant in the fetus.
Bethamethasone is contraindicated in... 1. Adequate Lecithin/Sphingomyelin Ratio. 2. Inability to delay delivery for 24-48 hours. 3. Delay of delivery is contraindicated.
Some side effects of Bethamethasone are... May initiate lactation; increase of infection; increase negative effects of placental insufficiency in PIH; increases risk of pulmonary edema when used with a tocolytic. Transient hyperglycemia, especially DM.
Nursing implications with Bethamethasome Most effective when used between 24 & 34 weeks gestation. Once over 2 days during pregnancy unless episodes of PTL d/t increased risk of IUGR. Give deep IM. Dexamethasome may be substituted.
Fentanyl: Sublimaze Classification (IM or IV) Narcotic Analgesic
How do you use Fentanyl? Management of pain.
How does Fentanyl work? Binds to Opiate receptors in the CNS altering the perception and emotional response to pain.
Do not use Fentanyl with... Premature labor; latent phase labor; transition phase labor; fetal distress; maternal hemorrhage.
Fentanyl may cause these side effects... Respiratory depression, light-headedness, dizziness, N/V, constipation, sedation, decreased FHT variability.
Fentanyl nursing implications 1. Don't give after Stadol or other narcs. 2. Not with premature labor. 3. Use in latent phase labor may decrease strength or interrupt uterine contractions. 4. Transition phase (4 hours prior to delivery may result in respiratory depressed infant).
Rubella Virus Vaccine: Meruvax II Classification (SC) Vaccine
Whats the Rubella Virus Vaccine used for in women? Administered to women with a rubella tier <1,000 to stimulate active immunity thereby protecting future trimester fetuses.
How does the Rubella Virus Vaccine work? Stimulates immunity against rubella by introducing a live attenuated virus.
What is the Rubella Virus Vaccine contraindicated in? Pregnancy, immunodeficiency conditions, (don't give the patient lives with a person with immune deficiency-due to live virus) respiratory or other active infections.
What are side effects of the Rubella Virus Vaccine? Encephalopathy, acute infection, anaphylaxis, fever. Exposure during pregnancy may cause fetal birth defects including retardation and deafness.
Nursing implications with Rubella Virus Vaccine... 1. Avoid pregnancy for 1 month after vaccine. Contraception. 2. Obtain Hx, allergies to other immunizations, chickens, ducks, feathers or rabbits. 3. No light, keep cold (the meds). 4. Use if clear, red, pink, or yellow.
Rogham: RhoGAm Classification (IM) Immunizing Agent
Whats Rogham for? To prevent Rh isoimmunization of Rh negative mothers exposed to Rh-positive RBC. Rho-(D) immune globin micro-dose is only for use after spontaneous or induced abortion or termination of ectopic pregnancy up to and including 12 weeks of gestation.
How does Rogham work? It suppresses immune response to RhoD factor, prevents hemolytic disease of newborn (erythroblastosis fettles) in subsequent pregnancies.
Contraindications of Rogham are... Rh positive women, thrombcytopenia or bleeding disorders.
Side effects of Rogham include... Discomfort at site, slight fever, lethargy, myalgia, splenomegaly.
Nursing implication with Rogham. 1. Infant cord blood to lab immediately after delivery. 2. Maternal Hx of allergies and reaction to immunizations. 3. Sample of post-delivery maternal blood to lab, determine amount of feto-maternal hemorrhage. 4. Cold storage. 5. Inject med into delt
Vitamin K: AquaMEPHYTON/Phytonadione (Vit K) Classification (IM) Synthetic Vitamin
Whats Vitamin K used for? Stimulate clotting in the newborn. Also used in Tx of hemorrhagic disease in infants.
Whats the action of Vitamin K? Stimulates hepatic synthesis of active prothrombin.
Vitamin K is contraindicated in... Hereditary hypoprothrombinemia ( Vit K can paradoxically worsen this).
Whats are some side effects of Vitamin K? Pain, swelling, hematoma at injections site, N/V, sweating, flushing, erythemia.
Nursing Implications of Vitamin K 1. Hold infant securely while administering injection. 2. Monitor blood for clotting action.
Erythromycin Eye Ointment: Ilotycin Opthalmic Classification (Opthalmic Ointment) Anti-infective
Whats Erythromycin Eye Ointment used for? Prophylactic Tx for newborns to prevent eye injury from gonorrhea and chlamydia conjunctivitis in neonates.
How does Erythromycin Eye Ointment work? Kills susceptible microorganisms by attacking bacterial cells.
Watch out for these contraindications with Erythromycin Eye Ointment... Hypersensitivity to erythromycins, required by state law.
Side effects of Erythromycin Eye Ointment Temporary blurred vision.
Nursing Implications with Erythromycin Eye Ointment: 1. Apply from inner to outer can thus along lower conjunctival sac. 2. Close eyelids and gently massage to spread ointment. 3. Do not touch tip of tube to any surface. 4. Dispose of tube after application.
Nifedipine (Procardia) Classification (PO) Calcium channel blocker (tocolytic and antihypertensive)
What is Nifedipine used for? Relax uterine smooth muscl to decrease pre-term contractions and delay labor.
How does Nifedipine work? Inhibits calcium ion influx across the muscle cell membrane to prevent muscular contraction in smooth muscle.
What are contraindications of Nifedipine? Hypersensitivity, arrhythmias, heart block, CHF, hypotension with SBP <90 hepatic injury or renal disease.
Whats some side effects of Nifedipine? light-headedness, edema, hypotension, dysrhythmias, Steven-Johnson Syndrome.
How does Nifedipine interfere with Lab tests? Positive ANA and Direct Coobs test.
Nursing Implications of Nifedipine 1. Monitor BP and HR. Rsik for falls. 2. Monitor contraction pattern for effectiveness. 3. Report SROM immediately. 4. NSAIDs may decrease the effectiveness of the medication.
Energix (Hep-B Vaccine) Classification (IM) Vaccine
Use of Energix Vaccine for Hepatitis B.
Side effects of Energix usually mild and well-tolerated. Most common are fatigue, headache and fever & local irritation at the site of injection.
Nursing Implications with Energix 1. Kids 12 mo and younger. Inject into anterolateral thigh. 2. Can be given at same time of HBIG when passive immunity is needed. 3. Monovalent Hep-B vaccine should be used for the initial (birth) dose in infants younger than 6 weeks of age. 4. Shake
Created by: jtzuetrong