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M6 13-005

Exam 10: Postpartum Medications

Postpartum The postpartum period occurs during the first six weeks post delivery.
Medical Issues: Reproductive System hemorrhoids, perineal trauma, episiotomy, lacerations, or bowel elimination.
Medical Issues: Cardiovascular System Hypervolemia
Medical Issues: Gastrointestinal System Constipation
Medical Issues: Urinary System UTI caused by urinary retention and overdistension.
Medical Issues: Musculoskeletal System muscle fatigue and aches.
Medical Issues: Integumentary System Stretch Marks
Medical Issues: Neurological System Temporary neurological changes (lack of feeling in legs and dizziness). Headache.
Medical Issues: Endocrine System hormonal changes.
Vaccine Types RHo (D) Immune Globulin (RhoGAM, Rhophylac, BayPho-D). Rubella vaccine (Meruvax II).
Pain Medications: Types Topical. Astringent pads. Analgesics.
Nonopioid Analgesics acetaminophen (Tylenol, Panadol). ibuprofen (Motrin, Advil). ketorolac (Toradol).
Opioid Analgesics darvocet-N (acetaminophen and propoxyphene). lortab (hydrocodone and acetaminophen). percocet (acetaminophen and oxycodone). tylox ( acetaminophen and oxycodone). vicodin (hydrocodone and acetaminophen). vicodin ES (hydrocodone and acetaminophen).
Laxatives: Types Fecal Wetting Agents. Saline Laxatives. Stimulant Laxatives. Suppositories. Simethicone.
Fecal Wetting Agents 1) docusate calcium (Surfak). 2) docusate sodium (Colace).
Saline Laxatives Milk of Magnesium.
Stimulant Laxatives bisacodyl (Dulcolax). casanthranol (Peri-Colace). senna (Senokot).
Suppositories Glycerine. Bisacodyl.
Oxytocic Medications methylergonovine maleate (Methergine). carboprost tromethamine (Hemabate, Prostin): discussed in previous Learning Step.
Newborn Care Meds Vitamin K1 (Phytonadione) Antiinfectives. Vaccines.
Newborn Antiinfectives Erythromycin Ophthalmic Ointment. Tetracycline.
Newborn Vaccines Hepatitis B Vaccine. Hepatitis B Immune Globulin (HBIG).
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Use Prevention and treatment of hypoprothrombinemia. Prevention of hemorrhagic disease of the newborn.
Hypoprothrombinemia, may be associated with: 1)Excessive doses of oral anticoagulants. 2)Salicylates. 3)Certain anti-infective agents. 4)Nutritional deficiencies. 5)Prolonged total parenteral nutrition.
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Action (a) Required for hepatic synthesis of blood coagulation factors II (prothrombin), VII, IX, and X. (b) Therapeutic Effects: prevention of bleeding due to hypoprothrombinemia.
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Precautions (a) Impaired liver function. (b) Severe life-threatening reactions have occurred following IV administration; use other routes unless risk is justified.
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Side Effects GI: gastric upset, unusual taste. Derm: flushing, rash, urticaria. Hemat: hemolytic anemia. Local: erythema, pain at injection site, swelling. Misc: allergic reactions, hyperbilirubinemia (large doses in very premature infants), kernicterus.
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Interactions Large doses will counteract the effect of warfarin. Large doses of salicylates or broad-spectrum anti-infectives may increase vitamin K requirements. Bile acid sequestrants, mineral oil, and sucralfate may decrease vitamin K absorption from the GI tract
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Nursing Implications (Adult) Monitor for frank & occult bleeding. Monitor pulse ad BP frequently. Inform other personnel of bleeding tendencies. Monitor Labs.
Phytonadione (Vitamin K1, AquaMEPHYTON, Mephyton): Nursing Implications (Peds) Monitor for side effects and adverse reactions. Children may be especially sensitive to the effects of vitamin K, which may increase incidence of side effects. Neonates, especially premature neonates, may be more sensitive than older children.
RHo (D) Immune Globulin: RhoGAM, Rhophylac, BayPho-D: Action Prevents production of anti-Rh (D) antibodies in Rh-negative women who have been exposed to Rh-positive blood by suppressing the immune reaction of the Rh-negative woman to the antigen in Rh-positive blood.
RHo (D) Immune Globulin: RhoGAM, Rhophylac, BayPho-D: Indications Administered to Rh-negative women who have been exposed to Rh-positive blood
RHo (D) Immune Globulin: RhoGAM, Rhophylac, BayPho-D: Contraindications & Precautions Women who are Rh-positive or women previously sensitized to Rh (D) should not receive Rh (D) immune globulin.
Rubella vaccine (Meruvax II): Action Vaccination produces a modified rubella (German measles) infection that is not communicable, causing the formation of antibodies against rubella virus.
Rubella vaccine (Meruvax II): Indications Vaccine is administered after childbirth or abortion or at least 4 weeks before pregnancy to women whose antibody screen show they are not immune to rubella.
Rubella vaccine (Meruvax II): Contraindications women who are immunosuppressed, pregnant, or sensitive to neomycin or eggs and in women who have a respiratory tract or febrile infection, active untreated tuberculosis, or conditions that affect the bone marrow or lymphatic system.
Rubella vaccine (Meruvax II): Nursing implications Pregnancy not advised until 4 weeks after vaccine is give due to the possibility that a fetus might be affected by the live virus in the vaccine.
Pitocin: action Stimulates uterine smooth muscle producing uterine contractions
Pitocin: Indications Maintenance of firm uterine contractions after birth to control postpartum hemorrhage.
Pitocin: nursing Considerations Observe uterus for firmness, height, and deviation. Message until firm if uterus boggy. Assess vital signs every 15 min or according to SOP. Monitor I&O and breath sounds to identify fluid retention or bladder retention.
Methylergonovine maleate (Methergine): Action Stimulates sustained contraction of the uterus and causes arterial vasoconstriction.
Methylergonovine maleate (Methergine): Indications Used for the prevention and treatment of postpartum or postabortion hemorrhage caused by uterine stony or subinvolution.
Methylergonovine maleate (Methergine): Contraindications and Precautions Contraindicated for women with hypertension, severe hepatic or renal disease, thrombophlebitis, coronary artery disease, peripheral vascular disease, hypocalcemia, or sepsis or before fourth stage of labor.
Methylergonovine maleate (Methergine): Nursing considerations Before administering, assess B/P. Follow unit SOP to determine at what BP level medication must be withheld.
Methylergonovine maleate (Methergine): Patient/Family Teaching Caution mother to avoid smoking because nicotine constricts blood vessels. Do not skip dose or double up if missed. If missed, omit and return to regular dose schedule
Carboprost tromethamine (Hemabate, Prostin): Action Stimulates contraction of the uterus.
Carboprost tromethamine (Hemabate, Prostin): Indications Used for the treatment of postpartum hemorrhage caused by uterine atony. Also used for abortion.
Carboprost tromethamine (Hemabate, Prostin): Contraindications and precautions Contraindicated for women with hypersensitivity to carboprost or other prostaglandins. Use caution of woman has a history of asthma, hypotension or hypertension, anemia, jaundice, diabetes, epilepsy, previous uterine surgery.
Carboprost tromethamine (Hemabate, Prostin): Adverse Reactions Excessive dose may cause titanic contraction and/or uterine rupture. May cause uterine hypertonus if used with oxytocin. N&V, diarrhea (frequent), fever, chills, facial flushing, H/A, hypertension or hypotension, tachycardia, pulmonary edema.
Carboprost tromethamine (Hemabate, Prostin): Nursing Considerations Should be refrigerated. Give via deep IM injection and aspirate carefully to avoid IV injection. Rotate sites if repeated. Monitor vital signs, administer antiemetics and antidiarrheals as ordered
Cytotec (misoprostol) and Prostin E2 (Dinoprostone) Given rectally may also be used to control bleeding.
Hepatitis B Vaccine (Recombivax, Engerix-B): Action Provides immunization against Hepatitis B infection
Hepatitis B Vaccine (Recombivax, Engerix-B): Indications Prevention of hepatitis B in exposed and unexposed infants.
Hepatitis B Vaccine (Recombivax, Engerix-B): Contraindications Hypersensitivity to yeast
HEPATITIS B IMMUNE GLOBULIN (HBIG): Action Provides antibodies and passive immunity to hepatitis B
HEPATITIS B IMMUNE GLOBULIN (HBIG): Indications Prophylaxis for infants of hepatitis B surface antigen-positive mothers.
Created by: jtzuetrong