Maternal Medications in Labor and Delivery

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Questions and Answers

Which medication's primary use is to counteract magnesium sulfate toxicity?

  • Ephedrine
  • Nifedipine
  • Calcium Gluconate (correct)
  • Penicillin G

A patient experiencing maternal hypotension requires which medication?

  • Misoprostol
  • Dinoprostone
  • Ephedrine (correct)
  • Penicillin G

Which of the following medications is administered via a tampon-like vaginal insert?

  • Dinoprostone (correct)
  • Misoprostol
  • Nifedipine
  • Calcium Gluconate

Which medication has a contraindication of previous uterine surgery?

<p>Misoprostol (C)</p> Signup and view all the answers

A patient with a known hypersensitivity to penicillins should not be prescribed which of the following?

<p>Penicillin G (D)</p> Signup and view all the answers

Which medication is used to inhibit uterine activity in preterm labor?

<p>Nifedipine (D)</p> Signup and view all the answers

A patient is experiencing uterine hyperstimulation. Which medications side effect should be suspected?

<p>Misoprostol and Dinoprostone (B)</p> Signup and view all the answers

Which medication requires the nurse to monitor the patient for potential allergic reactions?

<p>Penicillin G (D)</p> Signup and view all the answers

Which medication is contraindicated in a patient with a known opioid dependency due to the risk of withdrawal symptoms?

<p>Butorphanol (D)</p> Signup and view all the answers

Decreased Fetal Heart Rate variability is a potential side effect of which medication?

<p>Both Butorphanol and Nalbuphine (D)</p> Signup and view all the answers

A patient is receiving magnesium sulfate for preeclampsia. Which of the following assessment findings would be a priority to report to the physician?

<p>Visual Changes or Difficulty Breathing (B)</p> Signup and view all the answers

A patient is receiving oxytocin for labor augmentation. Which finding requires immediate notification of the provider?

<p>Uterine hyperstimulation (B)</p> Signup and view all the answers

A newborn is prescribed Vitamin K. What is the primary route of administration for this medication?

<p>IM (C)</p> Signup and view all the answers

Which medication requires the nurse to monitor for deep tendon reflexes (DTRs) as part of the standard nursing assessment?

<p>Magnesium Sulfate (B)</p> Signup and view all the answers

Betamethasone is administered to a pregnant client to:

<p>Promote fetal lung maturity (B)</p> Signup and view all the answers

Erythromycin eye ointment is administered to newborns to prevent what condition?

<p>Eye inflammation caused by gonorrhea and chlamydia (A)</p> Signup and view all the answers

A patient is prescribed nalbuphine during labor. What is the recommended timing of administration to minimize neonatal effects?

<p>Administer to deliver within 1 hr or after 4 hrs (A)</p> Signup and view all the answers

Which medication requires parental consent prior to administration to a newborn?

<p>Hepatitis B vaccine (B)</p> Signup and view all the answers

Which medication is contraindicated for a patient with a history of cardiac arrhythmias?

<p>Terbutaline (A)</p> Signup and view all the answers

Which of the following is a nursing consideration for a patient receiving promethazine?

<p>Ensure IV site integrity if given IV, and monitor for sedation and fall risk (A)</p> Signup and view all the answers

A client receiving labetalol reports dizziness. What is the priority nursing action?

<p>Monitor blood pressure and heart rate (A)</p> Signup and view all the answers

A neonate is experiencing respiratory depression due to narcotics administered during labor. Which medication is indicated to counteract this?

<p>Naloxone (C)</p> Signup and view all the answers

For a patient receiving butorphanol during labor, it is critical to have which medication readily available?

<p>Naloxone (B)</p> Signup and view all the answers

Tranexamic acid is administered in postpartum hemorrhage to:

<p>Stabilize clotting to reduce bleeding (C)</p> Signup and view all the answers

A patient is prescribed magnesium sulfate. Besides the loading dose, what is the maintenance infusion rate?

<p>1-4 g/hr (B)</p> Signup and view all the answers

For which primary condition is morphine used in a newborn?

<p>Neonatal abstinence syndrome (A)</p> Signup and view all the answers

A neonate is at risk for developing sepsis, especially with a suspected GBS case. Which medication is typically administered for prophylaxis?

<p>Ampicillin (C)</p> Signup and view all the answers

What is the recommended route of administration for betamethasone?

<p>Intramuscular (D)</p> Signup and view all the answers

A client is prescribed terbutaline for preterm labor. Which side effect should the client be educated to report immediately?

<p>Chest pain or difficulty breathing (B)</p> Signup and view all the answers

Which of the following is a key nursing consideration when administering Gentamicin to a newborn?

<p>Monitoring for ototoxicity and nephrotoxicity. (D)</p> Signup and view all the answers

When is erythromycin eye ointment typically administered to a newborn?

<p>Within 1 to 2 hours after birth (C)</p> Signup and view all the answers

Which of the following indicates a contraindication for administration of tranexamic acid?

<p>History of a thromboembolic event (B)</p> Signup and view all the answers

Flashcards

Butorphanol (Stadol)

An IV medication used for pain management during labor.

Contraindications of Butorphanol

Hypersensitivity and opioid dependency hinder Butorphanol use.

Side Effects of Butorphanol

Can cause decreased fetal heart rate variability and respiratory depression.

Administration of Butorphanol

1-2 mg IV, smallest effective dose; monitor maternal and fetal status.

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Nalbuphine (Nubain)

IV drug used for pain management in labor, with specific timing for dosing.

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Contraindications of Nalbuphine

Should not be used in hypersensitivity or opioid dependence cases.

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Promethazine (Phenergan) Uses

IM or IV medication for nausea/vomiting during labor, also as anesthesia adjunct.

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Magnesium Sulfate Functions

Used IV for preterm labor and seizure prophylaxis in preeclampsia.

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Vitamin K (Phytonadione)

Essential vitamin for blood clotting; administered IM to newborns to prevent hemorrhagic disease.

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Erythromycin Eye Ointment

Topical ointment to prevent eye inflammation from gonorrhea/chlamydia; applied within 1-2 hours of birth.

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Hepatitis B Vaccine

IM vaccine to prevent hepatitis B infection in newborns; requires parental consent and a specific schedule.

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Naloxone

Medication for correcting respiratory depression due to narcotics during labor; available IV, IM, or SubQ.

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Morphine

Pain management drug administered IV or IM; treats neonatal abstinence syndrome.

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Ampicillin

Prophylactic IV antibiotic for neonatal sepsis, especially in suspected GBS cases.

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Gentamycin

IV antibiotic used with ampicillin for neonatal sepsis; monitor for ototoxicity and nephrotoxicity.

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Client Teaching

Providing information to parents about the importance of medications and their purpose.

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Calcium Gluconate

An antidote for magnesium sulfate toxicity administered IV.

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Ephedrine

IV medication used to treat maternal hypotension.

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Dinoprostone (Cervidil)

A vaginal insert for cervical ripening before labor.

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Misoprostol (Cytotec)

Medication for cervical ripening and postpartum hemorrhage.

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Penicillin G

IV antibiotic used for treating Group B Streptococcus.

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Nifedipine (Procardia)

Given orally to inhibit uterine activity in preterm labor.

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Contraindications

Conditions where a medication should not be used.

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Oxytocin (Pitocin)

A medication used for induction and augmentation of labor and to manage postpartum hemorrhage.

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Betamethasone (Celestone)

A corticosteroid given to promote fetal lung maturity and reduce respiratory distress in preterm infants.

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Terbutaline (Brethine)

A medication used to relax the uterus during tachysystole or preterm labor.

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Labetalol

A medication used to treat hypertensive disorders in pregnancy.

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Tranexamic Acid (TXA)

A drug used to reduce excessive bleeding in postpartum hemorrhage.

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Uterine Hyperstimulation

A side effect of oxytocin characterized by excessive uterine contractions.

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Monitor FHR

Assess fetal heart rate to ensure the fetus is responding well during labor and medication administration.

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Study Notes

Maternal/L&D/Postpartum/Newborn Medications

  • Butorphanol (Stadol):

    • Route(s): IV
    • OB Indications: Pain management during labor
    • Contraindications: Hypersensitivity to butorphanol; opioid dependency (risk of withdrawal symptoms)
    • Side Effects: Decreased fetal heart rate (FHR) variability, respiratory depression (mother and neonate)
    • Nursing Considerations: Administer the smallest effective dose (1-2 mg IV); monitor FHR, maternal respiratory rate, and sedation level; have naloxone available.
    • Client Teaching: Explain potential side effects and that medication crosses the placenta; report excessive drowsiness or difficulty breathing.

  • Nalbuphine (Nubain):

    • Route(s): IV
    • OB Indications: Pain management during labor
    • Contraindications: Hypersensitivity to nalbuphine; opioid dependency
    • Side Effects: Decreased FHR variability, fetal bradycardia, respiratory depression
    • Nursing Considerations: Administer 10-20 mg IV; time administration to minimize neonatal effects (deliver within 1 hour or after 4 hours); monitor FHR, maternal respiratory rate, and pain level.
    • Client Teaching: Inform about potential neonatal effects; report excessive sedation or difficulty breathing.

  • Promethazine (Phenergan):

    • Route(s): IM, IV (caution: can damage veins)
    • OB Indications: Nausea and vomiting (N/V) during labor; adjunct to anesthesia
    • Contraindications: Hypersensitivity to promethazine; severe respiratory depression
    • Side Effects: Drowsiness (fall risk)
    • Nursing Considerations: Monitor for sedation and fall risk; ensure IV site integrity if given IV.
    • Client Teaching: Avoid activities requiring alertness; request assistance with ambulation.

  • Magnesium Sulfate:

    • Route(s): IV (loading dose 4-6 g over 30-45 min, maintenance 1-4 g/hr)
    • OB Indications: Preterm labor; seizure prophylaxis in preeclampsia
    • Contraindications: Myasthenia gravis; severe renal failure
    • Side Effects: Blurred vision, headache, dizziness, nausea/vomiting
    • Nursing Considerations: Monitor BP, HR, RR, lung sounds, DTRS, LOC, and I&Os; keep calcium gluconate at bedside for magnesium toxicity.
    • Client Teaching: Explain purpose and potential side effects; report visual changes or difficulty breathing immediately.

  • Calcium Gluconate:

    • Route(s): IV
    • OB Indications: Antidote for magnesium sulfate toxicity
    • Contraindications: Hypercalcemia
    • Side Effects: Tingling, hypotension, bradycardia
    • Nursing Considerations: Administer slowly; monitor ECG and serum calcium levels.
    • Client Teaching: Explain that this medication counteracts magnesium toxicity.

  • Ephedrine:

    • Route(s): IV
    • OB Indications: Treat maternal hypotension
    • Contraindications: Hypertension, hyperthyroidism
    • Side Effects: Palpitations, tachycardia
    • Nursing Considerations: Monitor BP and HR every 3-5 minutes
    • Client Teaching: Inform patient about purpose and potential side effects (e.g., increased heart rate).

  • Dinoprostone (Cervidil):

    • Route(s): Vaginal (tampon-like insert)
    • OB Indications: Cervical ripening for labor induction
    • Contraindications: Active labor; uterine scarring
    • Side Effects: Uterine hyperstimulation, fever, chills
    • Nursing Considerations: Monitor FHR, contractions, cervical dilation, and maternal vital signs.
    • Client Teaching: Explain purpose; report severe pain or excessive contractions.

  • Misoprostol (Cytotec):

    • Route(s): PO, vaginally (cervical ripening); rectally (postpartum hemorrhage)
    • OB Indications: Cervical ripening; postpartum hemorrhage
    • Contraindications: Previous uterine surgery (risk of rupture)
    • Side Effects: Uterine hyperstimulation, fever, diarrhea

  • Penicillin G:

    • Route(s): IV (5 million units loading dose, then 2.5-3.0 million units every 4 hours)
    • OB Indications: Treatment of Group B Streptococcus (GBS)
    • Contraindications: Hypersensitivity to penicillins
    • Side Effects: Allergic reactions, diarrhea
    • Nursing Considerations: Monitor for allergic reactions; educate on purpose for neonatal infection prevention.
    • Client Teaching: Inform about purpose; report signs of allergic reaction.

  • Nifedipine (Procardia):

    • Route(s): PO
    • OB Indications: Preterm labor (inhibits uterine activity)
    • Contraindications: Hypotension, allergy to nifedipine
    • Side Effects: Dizziness, flushing, hypotension
    • Nursing Considerations: Monitor BP, contractions; caution with concurrent magnesium sulfate.
    • Client Teaching: Advise against sudden position changes; report dizziness or chest pain.

  • Oxytocin (Pitocin):

    • Route(s): IV (infusion pump), IM
    • OB Indications: Induction, augmentation of labor; postpartum hemorrhage
    • Contraindications: Fetal distress, uterine rupture risk
    • Side Effects: Uterine hyperstimulation, water intoxication
    • Nursing Considerations: Monitor FHR, contractions, cervical dilation, and bleeding; never give undiluted IV bolus.
    • Client Teaching: Explain purpose and potential side effects.

  • Betamethasone (Celestone):

    • Route(s): IM (12 mg q24h for 2 doses)
    • OB Indications: Promote fetal lung maturity; reduce respiratory distress syndrome risk
    • Contraindications: Hypersensitivity
    • Side Effects: Hyperglycemia, transient leukocytosis
    • Nursing Considerations: Monitor maternal glucose; educate on benefits for preterm infants.
    • Client Teaching: Inform parents about importance for preterm delivery outcomes.

  • Terbutaline (Brethine):

    • Route(s): SubQ
    • OB Indications: Uterine relaxation (tachysystole, preterm labor)
    • Contraindications: Cardiac arrhythmias, poorly controlled diabetes
    • Side Effects: Tachycardia, palpitations, tremors
    • Nursing Considerations: Monitor HR, BP, and contractions.
    • Client Teaching: Explain purpose and side effects; report chest pain or difficulty breathing.

  • Labetalol:

    • Route(s): IV, PO
    • OB Indications: Treat hypertensive disorders of pregnancy
    • Contraindications: Asthma, bradycardia
    • Side Effects: Dizziness, bradycardia, fatigue
    • Nursing Considerations: Monitor BP and HR; caution with severe asthma.
    • Client Teaching: Explain purpose; report lightheadedness or slow heart rate.

  • Tranexamic Acid (TXA):

    • Route(s): IV (1 g over 10 min; repeat after 30 min if needed)
    • OB Indications: Postpartum hemorrhage
    • Contraindications: Thromboembolic disorders
    • Side Effects: Nausea, vomiting, thrombosis
    • Nursing Considerations: Administer within 3 hours of delivery; monitor bleeding and clotting.
    • Client Teaching: Explain purpose; report pain, swelling, or redness in extremities.

  • Vitamin K (Phytonadione):

    • Route(s): IM
    • OB Indications: Prevent hemorrhagic disease in the newborn
    • Nursing Considerations: Administer soon after birth; monitor injection site
    • Client Teaching: Explain that vitamin K is essential for blood clotting and is routinely administered in the U.S.

  • Erythromycin Eye Ointment:

    • Route(s): Topical (ophthalmic)
    • OB Indications: Prevent inflammation of the eyes caused by gonorrhea and chlamydia
    • Nursing Considerations: Administer within 1-2 hours of birth; gently wipe excess ointment after 1 minute
    • Client Teaching: Inform parents that this is a routine and mandatory preventive measure in the U.S.

  • Hepatitis B Vaccine:

    • Route(s): IM
    • OB Indications: Prevent hepatitis B infection
    • Nursing Considerations: Requires parental consent; administer in the opposite leg from vitamin K; adhere to schedule (birth, 1-2 months, 6 months).
    • Client Teaching: Explain importance of vaccination; for infants of Hepatitis B-positive mothers, also administer HBIG.

  • Naloxone:

    • Route(s): IV, IM, SubQ
    • OB Indications: Correct respiratory depression due to narcotics during labor
    • Nursing Considerations: Have available during narcotic administration; monitor neonatal respiratory status.
    • Client Teaching: Explain purpose and that it counteracts opioid effects.

  • Morphine:

    • Route(s): IV, IM
    • OB Indications: Treatment for neonatal abstinence syndrome
    • Nursing Considerations: Monitor neonatal withdrawal symptoms and adjust dosing as needed.

  • Ampicillin:

    • Route(s): IV
    • OB Indications: Prophylaxis for neonatal sepsis, especially in suspected GBS cases
    • Nursing Considerations: Administer as ordered; monitor for allergic reactions.
    • Client Teaching: Explain purpose to prevent neonatal infections.

  • Gentamycin:

    • Route(s): IV
    • OB Indications: Used with ampicillin for neonatal sepsis
    • Nursing Considerations: Monitor for ototoxicity and nephrotoxicity; ensure correct dosing.
    • Client Teaching: Inform parents about its role in treating serious infections.

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