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labor & delivery

Oxytocics: oxytocis - uterine stimulants induction of labor (postterm pregnancy, PROM, preeclampsia) delivery of placenta (postpartum, miscarriage) mgmt. of postpartum hemorrhage. stress testing
dinoprostone a prostaglandin used to promote cervical ripening & to stimulate uterine contractions. complications: uterine tachysystole - monitor: VSs length, strength & duration of contractions. Assess fetal status.
Methylergonovine contracts the uterus & is used for emergency intervention for serious postpartum hemorrhage. complications: hypertensive crisis (headache, n/v, increased BP)
oxytocics - complications uterine rupture, uterine tachysytole, placental abruption, hyponatremia. RN consideration: monitor VSs, I&O, length, strength & duration of contractions, assess fetal status. avoid concurrent use w/MAOIs. CNS depressants increase effects.
oxytocin contraindications/precautions maternal factors: sepsis, an unripe cervic, active genital herpes, HX of multiple biths, uterine surgery. fetal factors: imm lungs, cephalopelvic disproportion, fetal malprstn, prolapsd umbl cord, fetal distrss, plactl abnormalities, threatened spontane
dinoprostone contraindications/precautions cesarean birth, fetal distress, vaginal bleeding. use w/caution w/maternal hx of hypotension, htn, athsma. avoid concurrent use w/other oxytocics increase effects, monitor VSs, uterine activity, fetal status.
methylergonovine contraindications/precautions HTN, preeclampsia, asthma, cardiac disease use only after delivery & not during labor. caution: w/maternal HX of severe renal or hepatic disease, DM, sepsis, epilepsy. avoid concurrent use w/vasopressors, ergots increase effects. monitor VSs.
nursing administration 1 milliunits/min every 30 to 60 min. monitor VSs 30 to 60 min. uterine contraction every 15 min. during 1st. stage of labor. every 5 min during 2nd. stage of labor, uterine tachysystole, FHR & rhythm
tocolytics medications Terbutaline, hydroxyprogesterone caproate, nifedipine, indomethacin, magnesium. delays delivery for 48 hours to allow maximum benefit of glucocorticoids to decrease the incidence of RDS.
terbutaline monitor VSs, blood glucose, potassium levels report A/Es. have propranolol available hypersensitivity: caution w/chronic/active hepatic disease, renal disease. interactions w/MAOIs, green tea, decrease effect of beta-blockers,
hydroxyprogresterone caproate inject site reactions: monitor for pain, swelling, itching & appearance of hives. caution: uncontrolled HTN, liver disese, hx of thrombosis, breast cancer.
nifedipine hypotsn, headache, dizziness, nausea . caution w/hypotsn, hepatic/ renal disease or acute MI. hypersensitivity: avoid conct use w/magnesium sulfate or terbutaline. avoid using w/grapefruit juice, ginkgo biloba, ginseng, melatonin, St. John's Wort.
Indomethacin Matl: n/v heartburn, GI bleed, thrombocytopenia Fetal: neona-tal pulmonary HTN, oligohydramnios. caution: GI bleeding, hyper-sensitivity, use <32wks. gest. for 48 hrs. avoid NSAIDs, alcohol, salicylates, mtr toxicity blurred vision, ringing in ears).
magnesium sulfate monitor serum magnesium level, limit fluids to 125ml/hr have calcium gluconate available. d/c infusion w/intolerable A/Es avoid concurrent use w/nifedipine. increase antihypertensives, calcium blockers, neuromuscular blockers, decrease effect digoxin
glucocorticoid meds: adm bet/n 24 & 34 wks of gestation. betamethasone 12mg IM for 2 doses 24hrs. apart dexamethasone 6mg IM for 4 doses 12 hours apart. releases enzymes that produce & release lung surfactant to stimulate lung maturity in a fetus.
opioids: fentanyl, butorphanol, nalbuphine adm w/in provide pain relief w/out causing respiratory depression in mother & fetus. adm IM or IV or IV during labor. complications: dry mouth, n/v, neonatal depression, tachycardia, hypotension, decreased FHR variability, sedation
opioids contraindications/precautions delivery w/in 1 to 4 hr of adm. if opioid is gven too soon, it can delay progression of labor. if given too late, it can depress neonatal resprations
Created by: gdimanche