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Questions and Answers
Why should iron and antacids be taken 2 hours apart?
Which antacid may lead to diarrhea as a side effect?
What is a nonpharmacologic measure to help manage constipation?
During pregnancy, which medication is preferred for pain relief?
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What is the maximum daily dose recommendation for acetaminophen during pregnancy?
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Which of the following medications is contraindicated during the third trimester of pregnancy?
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What effect can aspirin have during pregnancy?
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What should patients avoid when taking acetaminophen?
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What is a sign of uterine rupture that healthcare providers should monitor for?
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Which of the following is NOT a primary purpose of pharmacologic measures during the postpartum period?
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What is recommended when administering NSAIDs to postpartum patients?
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Which comfort measure is beneficial for relieving pain from perineal wounds after childbirth?
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What common effect can systemic analgesics have on postpartum patients?
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What is the primary use of Terbutaline in pregnancy?
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Which of the following is a maternal side effect of terbutaline?
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What is the therapeutic effect of Magnesium Sulfate in tocolytic therapy?
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Which condition is Magnesium Sulfate contraindicated?
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Which adverse reaction is associated with increasing severity of Magnesium Sulfate treatment?
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What should be monitored to assess the risk of magnesium toxicity?
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What is a therapeutic serum magnesium level?
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What indicates the need to report respiratory problems during Magnesium Sulfate therapy?
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What is a primary advantage of mixed narcotic agonist-antagonists?
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Which of the following drugs is commonly prescribed for pain control during labor?
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What is a common side effect of Dinoprostone?
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What is the role of Oxytocin during labor?
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Which narcotic agonist is often used for pain relief during labor?
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What condition is a contraindication for Dinoprostone use?
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What type of administration is used for Oxytocin during labor?
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Which medication is a naturally occurring prostaglandin E2?
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What is the purpose of administering antenatal corticosteroids to patients at risk for preterm delivery?
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Which two phospholipids make up surfactant in fetal lungs?
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What does the L/S ratio in amniotic fluid indicate?
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What is the first sign of magnesium toxicity in patients receiving magnesium sulfate?
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Which of the following categories describes elevated blood pressure without proteinuria after 20 weeks of gestation?
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Which of the following is NOT a nonpharmacologic measure for pain control during labor?
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What is the primary role of sedative-tranquilizer drugs during false labor or with ruptured membranes?
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Which medication is associated with treating preeclampsia and eclampsia?
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Study Notes
Iron and Antacids
- Iron and antacids should be taken 2 hours apart.
- Antacids can cause changes in bowel habits.
- Aluminum and calcium carbonate antacids can cause constipation, while magnesium antacids can cause diarrhea.
- Many antacids contain a combination of ingredients to minimize adverse effects.
TUMS
- TUMS are frequently used by pregnant patients for heartburn.
- TUMS are calcium-based and can contribute to constipation.
Constipation
- Nonpharmacologic measures: increased fluid intake, increased dietary fiber intake, and moderate physical exercise.
- Pharmacologic measures: Metamucil and Docusate Sodium (Colace).
- Avoid during pregnancy: Castor oil and mineral oil.
Pain
- Nonpharmacologic measures: rest, relaxation exercises, alteration in routine, mental imagery, ice packs or warm, moist heat, postural changes, correct body mechanics, and changes in footwear.
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Pharmacologic measures:
- Acetaminophen is the most commonly ingested nonprescription drug during pregnancy.
- Acetaminophen can be used during all trimesters for pain relief and fever reduction.
- Maximum daily dose recommendation: 3,000 mg.
- Aspirin can inhibit labor and prolong labor.
- Ibuprofen can cause premature closure of the ductus arteriosus.
Ductus Arteriosus
- Closes 2 days after birth.
Pain Nursing Implications
- Advise patients to take acetaminophen instead of aspirin during pregnancy.
- Aspirin and ibuprofen are contraindicated during the third trimester.
- Advise patients against taking multiple OTC pain or cough/cold preparations, as many contain acetaminophen.
- Advise patients not to take NSAIDs with acetaminophen.
- Advise patients not to take NSAIDs after the second trimester.
Terbutaline
- Used in the late second and early third trimesters.
Tocolytic Therapy
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Beta-Sympathomimetic Drugs:
- Maternal side effects: tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia.
- Fetal side effects: tachycardia and potential hypoglycemia due to fetal hyperinsulinemia caused by maternal hyperglycemia.
Magnesium Sulfate
- A calcium antagonist and central nervous system depressant, relaxes the smooth muscle of the uterus.
- Administered IV, it directly depresses uterine muscle contractility.
- Increases uterine perfusion, which is beneficial for the fetus.
- Contraindicated in: patients with myasthenia gravis, impaired kidney function, or recent myocardial infarction (MI).
- Adverse Reactions: flushing, warmth, perspiration, dizziness, nausea, headache, lethargy, slurred speech, sluggishness, nasal congestion, heavy eyelids, blurred vision, decreased GI action, increased pulse rate, and hypotension.
- Increased severity: depressed reflexes, confusion, and magnesium toxicity (respiratory depression and arrest, circulatory collapse, cardiac arrest).
- Antidote for magnesium toxicity: calcium gluconate (1 g IV push over 3 minutes).
Magnesium Sulfate Nursing Interventions
- Monitor vital signs, FHR, fetal activity, and uterine activity.
- Report respirations fewer than 12 per minute, indicating possible magnesium sulfate toxicity.
- Monitor intake and output (I&O), reporting urinary output below 30 mL/hour.
- Assess breath and bowel sounds every 4 hours.
- Assess deep tendon reflexes (DTRs) and clonus before and during therapy.
- Notify the healthcare provider of changes in DTRs or clonus.
- Assess pain and uterine contractions.
- Weigh patients daily at the same time.
- Monitor serum magnesium levels (therapeutic level is 4 to 7 mg/dL).
- Have calcium gluconate available as an antidote.
- Observe newborns for 24 to 48 hours for magnesium effects if the mother received the drug before delivery.
Corticosteroid Therapy in Preterm Labor
- Patients at risk for preterm delivery should receive antenatal corticosteroid therapy with betamethasone (Celestone) or dexamethasone.
- Antenatal corticosteroids accelerate lung maturation and surfactant development, reducing the incidence and severity of respiratory distress syndrome (RDS) and increasing survival of preterm infants.
Surfactant Development
- Surfactant is made up of two major phospholipids: sphingomyelin and lecithin.
- Sphingomyelin develops in greater quantity than lecithin at first.
- Lecithin production peaks around the 33rd to 35th weeks of gestation.
- The L/S (lecithin/sphingomyelin) ratio, measured in amniotic fluid, predicts fetal lung maturity and risk for neonatal RDS.
Gestational Hypertension
- Elevated blood pressure without proteinuria after 20 gestational weeks in a patient who was normotensive before pregnancy.
- Includes two categories: Preeclampsia and Eclampsia.
Preeclampsia/Eclampsia Pharmacologic Measures
- Magnesium sulfate: (Therapeutic levels: 4-7 mEq/L). First sign of Magnesium Toxicity: Loss of patellar reflexes.
- Methyldopa
- Hydralazine
- Labetalol
Pain Control During Labor
- Nonpharmacologic Measures: ambulation, supportive positioning, touch and massage, hygiene and comfort measures, support persons, breathing and relaxation techniques, transcutaneous electrical nerve stimulation (TENS), hypnosis, acupuncture, and hydrotherapy.
Sedative-Tranquilizer Drugs
- Commonly given for false labor, latent labor, or ruptured membranes without true labor.
- May also be administered to minimize maternal anxiety and fear.
- Promote rest and relaxation and decrease fear and anxiety, but they do not provide pain relief.
- Examples: Secobarbital (Seconal), pentobarbital (Nembutal), promethazine (Phenergan), hydroxyzine pamoate (Vistaril).
Narcotic Agonists
- Second group of drugs given for active labor.
- Interfere with pain impulses at the subcortical level of the brain.
- Opioids interact with mu and kappa receptors to effect pain relief.
- Examples: Meperidine (the most commonly prescribed synthetic opioid for pain control during labor) and fentanyl.
Mixed Narcotic Agonist-Antagonists
- Exert effects at multiple sites, often agonist at one site and antagonist at another.
- Primary advantage: dose-ceiling effect - additional doses do not increase respiratory depression.
- Respiratory depression ceiling effect is believed to result from activation of kappa agonists and weak mu antagonists.
- Examples: Butorphanol tartrate and Nalbuphine.
Drugs That Enhance Uterine Muscle Contractility
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Dinoprostone:
- The naturally occurring form of prostaglandin E2 (PGE2).
- Administered intra-cervically or intravaginally.
- Acts to create cervical effacement and softening.
- Side effects: uterine hyperstimulation.
- Adverse effects: chills, fever, vomiting, and diarrhea.
- Contraindications: active vaginal bleeding, known allergies to prostaglandins, hepatic or renal disease, glaucoma, previous cesarean delivery or hysterotomy.
Oxytocin
- Facilitates smooth-muscle contraction in the uterus of a patient already in labor but experiencing inadequate uterine contractility.
- Diluted and administered IV piggyback for induction or augmentation of labor.
Oxytocin Nursing Interventions
- Have tocolytic drugs (e.g., terbutaline) and oxygen readily available.
- Monitor intake and output.
- Monitor maternal pulse and BP, uterine activity, and FHR during oxytocin infusion.
- Maintain the patient in a sitting or lateral recumbent position to promote placental infusion.
- Monitor for signs of uterine rupture (FHR decelerations, sudden increased pain, loss of uterine contractions, hemorrhage, and rapidly developing hypovolemic shock).
- Use an IV pump to administer the drug.
Drugs Used During the Postpartum Period
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Primary purposes:
- Prevent uterine atony and postpartum hemorrhage.
- Relieve pain from uterine contractions, perineal wounds, and hemorrhoids.
- Enhance or suppress lactation.
- Promote bowel function.
- Enhance immunity.
Pain Relief for Uterine Contractions
- Systemic analgesics (e.g., codeine, meperidine) can cause decreased alertness.
- Observe patients carefully as they care for their newborns.
- Assess for bowel function and respirations.
- Nonsteroidal agents like ibuprofen and ketorolac tromethamine are used to control postpartum discomfort and pain.
- NSAIDs can cause GI irritation, so taking them with a full glass of water or food is recommended.
Pain Relief for Perineal Wounds and Hemorrhoids
- Pregnancy and delivery increase pressure on perineal soft tissue, causing ecchymosis or edema.
- Increased edema, ecchymosis, and pain may occur if an episiotomy or perineal laceration is present.
Comfort Measures for Perineal Wounds and Hemorrhoids
- Ice packs immediately after birth.
- Tightening the buttocks before sitting.
- Use of peribottles and cool or warm sitz baths.
- Topical agents (witch hazel and dibucaine ointment).
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Description
This quiz covers important information regarding the use of iron supplements and antacids, including their interactions and effects on bowel habits. It also addresses constipation management strategies, both pharmacologic and nonpharmacologic, along with considerations for pregnant patients. Test your knowledge on these topics and enhance your understanding of digestive health.
