Maternity Medications PDF

DRUGS FOR LABOR, DELIVERY, & THE POSTPARTUM PERIOD NP03L010 · Version 2.0 Introduction to Maternity and Pediatric Nursing, pp. 171-179, pp. 182-205 Introduction to Clinical Pharmacology, 10th Ed., Chapters 9, 12 -15, 18, & 20 Terminal Learning Objective Given a patient in a clinical environment & a...

DRUGS FOR LABOR, DELIVERY, & THE POSTPARTUM PERIOD NP03L010 · Version 2.0 Introduction to Maternity and Pediatric Nursing, pp. 171-179, pp. 182-205 Introduction to Clinical Pharmacology, 10th Ed., Chapters 9, 12 -15, 18, & 20 Terminal Learning Objective Given a patient in a clinical environment & a privileged provider’s medication order, administer antepartum, intrapartum, & postpartum medications to patient without error. Enabling Learning Objectives A. Given a patient in a clinical environment & a privileged provider’s medication order, administer antepartum medications to a pregnant patient without error. B. Given a patient in a clinical environment & a privileged provider’s medication order, administer intrapartum medications to a pregnant patient without error. C. Given a patient in a clinical environment & a privileged provider’s medication order, administer postpartum medications without error. Pharmacology Overview Intended Effect or Mechanism of Action What is the medication supposed to do? Side Effect Expected but unintended effects of the medication Adverse or Toxic Effect Unexpected, unintended effects of the medication Enabling Learning Objective: A Given a patient in a clinical environment & a privileged provider’s medication order, administer antepartum medications to a pregnant patient without error. HYPERTENSIVE DISORDERS Hypertensive Disorders in Pregnancy Chronic Hypertension Diagnosed prior to 20 weeks gestation or after 12 weeks postpartum Gestational Hypertension Blood pressure that exceeds 140/90 mmHg diagnosed after 20 weeks gestation Preeclampsia Blood pressure that exceeds 140/90 mmHg accompanied by proteinuria or other organ involvement Eclampsia Progression of preeclampsia into generalized seizures Hypertensive Disorders in Pregnancy Goal of Antihypertensive Therapy Decrease blood pressure Prevent end-organ damage Stroke CHF Goal of Anticonvulsant Therapy Normal serum magnesium levels Avoid magnesium toxicity Prevent eclamptic seizures Decrease frequency & strength of contractions In the event of preterm labor Hypertensive Disorders in Pregnancy ANTIHYPERTENSIVES Vasodilators Hydralazine (Apresoline) Increases cardiac output & blood flow to placenta Beta Blockers Labetalol (Normodyne) Reduce heart rate & vasoconstriction, reducing peripheral vascular resistance Calcium Channel Blockers Nifedipine (Procardia) Smooth muscle relaxation Also a tocolytic Hypertensive Disorders in Pregnancy Nursing Care Assist with prenatal care Coping with therapy Care of the acutely ill Monitor blood pressure & pulse Monitor I&O Perform daily weights Patient Education Caution patients to make position changes slowly due to potential for orthostatic hypotension Take meds as prescribed Notify provider if increased swelling of hands and feet Hypertensive Disorders in Pregnancy ANTICONVULSANTS Magnesium sulfate Purpose Decrease incidence & severity of seizures associated with eclampsia May be used concurrently with oxytocin Prevent uterine contractions In the event of preterm labor Relaxes uterine muscle Relaxes smooth muscle, reducing vasoconstriction Decreases blood pressure Increases blood flow to kidneys Hypertensive Disorders in Pregnancy Magnesium sulfate Mechanism of Action Decrease acetylcholine released by motor nerve impulses Blocks neuromuscular transmission Depresses CNS Anticonvulsant Decreases frequency & intensity of uterine contractions NOT an antihypertensive Smooth muscle relaxation results in reduced vasoconstriction, with consequent decrease in blood pressure Hypertensive Disorders in Pregnancy Magnesium sulfate Side Effects Depressed CNS Depressed deep tendon reflexes Depressed respirations Therapeutic Serum Level 4-8 mg/dL Magnesium Toxicity Absent DTR RR less than 12 bpm Altered LOC Hypertensive Disorders in Pregnancy Nursing Implications MgSO4 via secondary IV Monitor neurologic status Provide quiet environment Bedrest, lying on left side Monitor VS If seizures occur TWO nurse check required Initiate seizure precautions Deep tendon reflexes Prevent injury Restore oxygenation Hypertensive Disorders in Pregnancy Nursing Care Postpartum therapy is continued for at least 12-24 hours Eclampsia threat continues Close monitoring for 48 hours Risk for pulmonary edema, renal failure and convulsions Labetalol is the antihypertensive medication of choice postpartum Check on Learning A 34-year-old female G3P2 who is 34 weeks gestation who has been being treated for gestational hypertension. Today, she appears uncomfortable, has 3+ pitting edema of BLE, heart sounds are regular, equal peripheral pulses, A&Ox4, C/O headache and sees spots, reflexes +3, urine +2 proteinuria, no contractions. Current VS: PQRST Pain Assessment T: 98.4 F Provoking None P: 84 regular Quality Stabbing/throbbing R: 20 regular Region/Radiation Eyes, forehead BP: 168/98 Severity 5/10 O2 sat: 95% room air Timing Constant, unrelieved by acetaminophen Check on Learning A 34-year-old female G3P2 who is 34 weeks gestation who has been being treated for gestational hypertension. Today, she appears uncomfortable, has 3+ pitting edema of BLE, heart sounds are regular, equal peripheral pulses, A&Ox4, C/O headache and sees spots, reflexes +3, urine +2 proteinuria, no contractions. What vital sign data is relevant and must be recognized as clinically significant? Check on Learning A 34-year-old female G3P2 who is 34 weeks gestation who has been being treated for gestational hypertension. Today, she appears uncomfortable, has 3+ pitting edema of BLE, heart sounds are regular, equal peripheral pulses, A&Ox4, C/O headache and sees spots, reflexes +3, urine +2 proteinuria, no contractions. What assessment data are relevant and must be recognized as clinically significant? Check on Learning A 34-year-old female G3P2 who is 34 weeks gestation who has been being treated for gestational hypertension. Today, she appears uncomfortable, has 3+ pitting edema of BLE, heart sounds are regular, equal peripheral pulses, A&Ox4, C/O headache and sees spots, reflexes +3, urine +2 proteinuria, no contractions. After interpreting, relevant data, what is the primary problem? Check on Learning A 34-year-old female G3P2 who is 34 weeks gestation who has been being treated for gestational hypertension. Today, she appears uncomfortable, has 3+ pitting edema of BLE, heart sounds are regular, equal peripheral pulses, A&Ox4, C/O headache and sees spots, reflexes +3, urine +2 proteinuria, no contractions. What is the rationale and expected outcomes of the following medical plan? Labetalol 20 mg IV X1 Magnesium sulfate IV infusing at 2 g/hr. DIABETES MELLITUS Diabetes Mellitus in Pregnancy Type 1 DM: Pregestational Absolute insulin deficiency Typically require insulin Type 2 DM: Pregestational Insulin Resistance Many modifiable risk factors Gestational DM Carbohydrate or glucose intolerance Onset or diagnosis in pregnancy Diabetes Mellitus in Pregnancy Treatment Identification of GDM Oral Glucose Tolerance Test 24-28 weeks Blood glucose level > 130-140 mg/dL is abnormal 2 abnormal 3-hour OGTT lead to diagnosis of GDM Diet Modifications Monitoring blood glucose levels Monitoring ketones Insulin administration Diabetes Mellitus in Pregnancy Glyburide Oral hypoglycemic drug Does not cross the placenta May require supplemental injectable insulin Diabetes Mellitus in Pregnancy INSULIN Mechanism of Action Increase transport of glucose into cells Maintains stores of fatty acids, glycogen and protein Inhibits the release of fatty acids in the blood TYPES OF INSULIN Rapid Acting Type Insulin Aspart (Novolog) Insulin Lispro (Humalog) Insulin Glulisine (Apirdra) Route Onset Peak Duration SQ 15 Mins 1-2 Hrs 3-5 Hrs SQ 15 Mins 1-2 Hrs 3-5 Hrs SQ 15-30 Mins 0.5-2.5 Hrs 3-6.5 Hrs Short Acting Regular Insulin (Humulin R, Novolin R, Iletin II) Regular Insulin (Humulin R, Novolin R, Iletin II) SQ 30-60 Mins 2.5 Hrs 6-10 Hrs IV 10-30 Mins 15-30 Mins 30-60 Mins Intermediate Acting NPH Lente SQ SQ 1-2 Hrs 1-3 Hrs 4-8 Hrs 8-12 Hrs 10-18 Hrs 18-28 Hrs Diabetes Mellitus in Pregnancy INSULIN Dosage Adjustments Pregnancy increases need & frequency of dosing Fast acting insulins given before meals Injection Administration Syringes are marked & measured in “units” U-100 = 100 units in mL Increments of 2 U-50 = 50 units in 0.5mL Increments of 1 Diabetes Mellitus in Pregnancy INSULIN Side Effects Swelling, itching or redness around the injections site Lipodystrophy Hypoglycemia Hunger Trembling Weakness Faintness Lethargy Headache Irritability Sweating Pale, cool, moist skin Blurred vision Loss of consciousness Diabetes Mellitus in Pregnancy INSULIN Nursing Implications Insulin via SQ injection or IV TWO nurse check required Assess for hypoglycemic reactions Teaching Self care Prescribed diet and food selection Recognize and respond to hypo/hyperglycemia Maintain glycemic control Diabetes Mellitus in Pregnancy GESTATIONAL Patient Education Mixing insulins in one syringe Regular insulin = Clear NPH = Cloudy DRAW CLEAR BEFORE CLOUDY! Understanding sliding scale Measures to prevent hypoglycemia How to administer insulin injections Rotate injection sites Equipment Syringe disposal Diabetes Mellitus in Pregnancy PREGESTATIONAL Patient Education First Trimester Insulin needs decrease due to antiinsulin placental hormones & fetal consumption of glucose Second & Third Trimesters Insulin needs increase due to maternal insulin resistance, allowing build-up for fetal growth Labor & Delivery Maternal euglycemia key to prevent neonatal hypoglycemia May need insulin IV drip Postpartum Insulin needs decline rapidly due to abrupt cessation of placental hormones Monitor blood glucose closely & adjust insulin as needed Diabetes Mellitus in Pregnancy PREGESTATIONAL Patient Education Review signs of hypoglycemia & hyperglycemia Review treatment of hypoglycemic episodes Review correct procedure for glucose monitoring Encourage appropriate diet, exercise, & medication regimen Review proper insulin administration Some women may want to maintain previously prescribed insulin pump CARDIAC DISEASE Cardiac Disease in Pregnancy Cardiac failure Increased heart rate Increased blood volume Increased cardiac output Increased physiological strain leads to heart failure Cardiac Disease in Pregnancy Goal of Anticoagulant Therapy Prevent undesired clotting Heparin Prevent stroke, MI, & death Goal of Diuretic Therapy Control CHF manifestations Furosemide (Lasix) Thiazides Goal of Antidysrhythmia Therapy Control cardiac dysrhythmias Digitalis Cardiac Disease in Pregnancy ANTICOAGULANTS Purpose Prevent clot extension & formation Coumadin contraindicated in pregnancy due to teratogenic effects on fetus! Mechanism of Action Inhibit steps in fibrin formation cascade Prolongs bleeding time NOT a clot dissolver Cardiac Disease in Pregnancy ANTICOAGULANTS Side Effects Easy bruising, bleeding Pain, redness, irritation at injection site Thrombocytopenia Allergic reaction Early signs of bleeding Excessive bleeding gums Unusual bruising Tarry, black stools Hematuria Tachycardia Hypotension Shortness of breath GI pain Cardiac Disease in Pregnancy ANTICOAGULANTS Nursing Implications Assess bleeding & hemorrhage Assess for thrombosis S x S dependent upon location Assess for allergic reaction Antidote is Protamine Sulfate for Monitor labs for therapeutic effect Activated partial thromboplastin time (aPTT) Platelets counts Cardiac Disease in Pregnancy ANTICOAGULANTS Administration Administer via IV or SQ Do not aspirate Rotate sites frequently Avoid rubbing injection area Double check the dose drawn up with another nurse Monitor aPTT, platelets 1.5 -2.5 times the control Patient Education Report any unusual signs of bleeding Advise patient to avoid products containing Aspirin NSAIDS Cardiac Disease in Pregnancy DIURETICS Purpose Decrease fluid volume excess in CHF Lasix Nursing Implications Monitor fluid & electrolyte balance closely Assess changes in VS Carefully assess for dehydration ANEMIA Anemia in Pregnancy Iron Deficiency Folic Acid Deficiency Sickle Cell Thalassemia Anemia in Pregnancy Goal of Iron Supplementation Improved nutritional status Increased energy levels Absence of fatigue Iron Supplements Ferrous Sulfate Goal of Folate Supplementation Resolution of megaloblastic anemia signs & symptoms Folate Supplements Folate Vitamin B9 Anemia in Pregnancy IRON SUPPLEMENTS Purpose Prevention & treatment of irondeficiency anemia Mechanism of Action Iron serves as oxygen carrier in hemoglobin & myoglobin Critical for tissue respiration Anemia in Pregnancy IRON SUPPLEMENTS Side Effects Constipation Dark stool color GI irritation, nausea Anemia in Pregnancy IRON SUPPLEMENTS Nursing Implications Oral Administration Give on empty stomach or 2 hours after meal Vitamin C helps with absorption Avoid milk or antacids Monitor labs for therapeutic effect CBC, Hgb & Hct Serum ferritin & iron Assess nutritional status & dietary history to determine cause Anemia in Pregnancy IRON SUPPLEMENTS Patient Education Take with a full glass of water or orange juice Sit upright for 10 minutes after taking to avoid esophageal irritation Do not crush or chew medication Instruct patient to consume high-iron diet Meats, chicken, fish & liver Dried beans & fruits Eggs Dark green, leafy vegetables Anemia in Pregnancy FOLATE SUPPLEMENTS Purpose Prevention & treatment of megaloblastic & macrocytic anemias In pregnancy, promotes normal fetal development & prevents neural tube defects Mechanism of Action Coenzyme in synthesis of DNA Essential nutrient in formation of RBCs Anemia in Pregnancy FOLATE SUPPLEMENTS Nursing Implications Women of reproductive age should take folic acid supplement daily 400 - 800 mcg Assess patient for signs of megaloblastic anemia Fatigue Weakness Dyspnea Monitor labs for therapeutic effect Plasma folic acid Hct, Hgb, & reticulocytes Anemia in Pregnancy FOLATE SUPPLEMENTS Patient Education Encourage compliance with diet recommendations Fortified grains, bread, rice Green beans Legumes Asparagus Fresh, leafy green vegetables Check on Learning Which outcome statement best indicates that the plan of care for the patient with gestational diabetes is successful? a. b. c. d. Patient continues in euglycemic state Patient reports dietary compliance Patient shows weight gain as expected Patient can self-administer insulin Check on Learning You are caring a patient with heart disease who is pregnant. She is being placed on bed rest do to worsening heart failure. She is being prescribed Heparin as asks you to explain the purpose of this treatment. What is your best response? a. b. c. d. Anticoagulants are used to lyse existing clots Anticoagulants are used to increase the flow of blood to your heart Anticoagulants are used to prevent new clot formation Anticoagulants are used to thing the viscosity of the blood Enabling Learning Objective: B Given a patient in a clinical environment & a privileged provider’s medication order, administer intrapartum medications to a pregnant woman without error INDUCTION OF LABOR Induction of Labor The intentional initiation of labor before it begins naturally Goal of Therapy Onset of effective contractions Frequency every 2-3 minutes Duration of 40-90 seconds Intensity is firm to palpation or IUPC reading of 50-80 mmHg Avoid tachysystole & hypertonicity Less than 30 seconds between contractions Last longer than 90 seconds Fetal distress Induction of Labor OXYTOCIN (PITOCIN) Purpose Induction of labor Elective must be term Medical indications may be done preterm Augmentation of labor Facilitation of threatened abortion Prevention or treatment of postpartum hemorrhage Promote milk letdown in lactating women Induction of Labor OXYTOCIN (PITOCIN) Mechanism of Action Stimulates smooth muscle contraction Triggers contractions in uterine smooth muscle Triggers milk ejection reflex in mammary gland smooth muscle Has vasopressor & antidiuretic effects Induction of Labor OXYTOCIN (PITOCIN) Side Effects Hypotension Hypertension Dysrhythmias Headache Anorexia, N/V Adverse Effects Hypertonicity or tachysystole Uterine rupture Abruptio placentae Water toxicity Impaired uterine blood flow Fetal distress Brady or tachycardia Late decelerations Decreased variability Induction of Labor OXYTOCIN (PITOCIN) Nursing Implications Oxytocin via secondary IV TWO nurse check required Titratable dose Determine fetal maturity, presentation, & pelvic adequacy prior to administration Assess frequency, duration, intensity, & resting tone of contractions Continuous EFM STOP infusion in the event of fetal distress or hyperstimulation Perform intrauterine resuscitation measures Notify HCP Monitor blood pressure & pulse PRETERM LABOR Preterm Labor Regular contractions that result in cervical dilation after 20 weeks gestation but prior to 37 weeks gestation May result in preterm delivery Preterm Labor Goal of Tocolytic Therapy Decrease or cessation of uterine contractions Allow fetus to mature Goal of Corticosteroids Increase fetal lung maturity Preterm Labor Tocolytics Magnesium sulfate Calcium Channel Blockers Nifedipine Prostaglandin Synthesis Inhibitors Indomethacin Beta-Adrenergics Terbutaline Corticosteroids Betamethasone Preterm Labor Purpose Stop preterm labor via tocolysis Drug of Choice Nifedipine (Procardia) Mechanism of Action Blocks Ca entry into cells of smooth muscle Decreases rate & force of contractions in uterus & myocardium Dilates coronary arteries & inhibits coronary artery spasm Preterm Labor CALCIUM CHANNEL BLOCKERS Side Effects Orthostatic hypotension Headache Dizziness Flushing Fluid retention Preterm Labor CALCIUM CHANNEL BLOCKERS Nursing Implications Monitor blood pressure & pulse Monitor I&O Monitor daily weights Assess for signs of CHF Monitor contraction frequency & duration Patient Teaching Caution patients to make position changes slowly due to potential for orthostatic hypotension Preterm Labor PROSTAGLANDIN SYNTHESIS INHIBITORS Purpose Stop preterm labor via tocolysis Drug of Choice Indomethacin Mechanism of Action Inhibit synthesis of prostaglandins that stimulate smooth muscle of the uterus to contract Preterm Labor PROSTAGLANDIN SYNTHESIS INHIBITORS Side Effects Maternal Nausea Vomiting Heartburn May prolong bleeding time Fetal Constriction of PDA Causing fetal death Oligohydramnios Causes reduction of amniotic fluid Preterm Labor PROSTAGLANDIN SYNTHESIS INHIBITORS Nursing Implications Observe for abnormal bleeding or bruising Anti-inflammatory response may mask infection or fever Monitor contraction frequency & duration Assess EFM & fetal movement to determine fetal condition Preterm Labor PROSTAGLANDIN SYNTHESIS INHIBITORS Patient Education Take medication with full glass of water or food Avoid concurrent use of alcohol, aspirin, NSAIDs & other OTC medications Advise patient to monitor & report decreased fetal movement Preterm Labor BETA-ADRENERGICS Purpose Stop preterm labor via tocolysis Drug of Choice Terbutaline Brethaire Mechanism of Action Smooth muscle relaxant Produces bronchodilation & uterine relaxation Due to cardiovascular effects, FDA has not approved terbutaline for tocolysis! Preterm Labor BETA-ADRENERGICS Side Effects Tachycardia Cardiac dysrhythmias Chest pain Dyspnea Hyperglycemia Nursing Implications Monitor blood pressure & pulse Monitor blood glucose Monitor contraction frequency & duration Assess EFM to determine fetal condition Discontinue 2 hours before delivery to avoid newborn side effects Preterm Labor BETA-ADRENERGICS Patient Education Notify HCP of the following: Labor resumes Significant side effects Preterm Labor CORTICOSTEROIDS Purpose Facilitate fetal lung maturity & prevent intraventricular brain hemorrhage Drug of Choice Betamethasone Mechanism of Action Accelerates surfactant production Reduce high pressure in cerebral blood flow Preterm Labor CORTICOSTEROIDS Side Effects Sodium and fluid retention Hyperglycemia Elevated blood pressure Preterm Labor CORTICOSTEROIDS NURSING IMPLICATIONS Monitor vitals signs Hypertension Monitor blood glucose Identify potential signs of infection Elevated temperature & heart rate Assess lung sounds to identify pulmonary edema PATIENT EDUCATION Notify HCP of the following: Signs & symptoms of infection Shortness of breath Dyspnea on exertion Check on Learning Identify the class of drug or drug name from the following descriptions of their main purpose. a. Stimulate labor contractions b. Inhibit uterine contractions c. Speed fetal lung maturation CERVICAL RIPENING Cervical Ripening Cervical Ripening Pharmacological, hormonal, or mechanical softening & thinning of the cervix in preparation for labor Goal of Prostaglandins Ripens cervix in pregnancy at or near term when induction of labor is indicated Cervical Ripening PROSTAGLANDINS Vaginal Inserts Dinoprostone (Cervidil) Vaginal or Oral Tablets Misoprostol (Cytotec) Mechanism of Action Stimulates myometrium, which then produces uterine contractions Oxytocic effect Initiates softening, effacement, & dilation of the cervix Cervical Ripening PROSTAGLANDINS Side Effects Uterine contraction abnormalities (tachysystole) Back pain Warm feeling in vagina Nausea and vomiting Fetal heart rate abnormalities (bradycardia) Cervical Ripening PROSTAGLANDINS Nursing Implications Administration Must be given in setting where fetal monitoring & emergency care is immediately available Place patient in left, lateral recumbent position Monitor cervical status Monitor contraction frequency & duration Monitor EFM to determine fetal condition Cervical Ripening PROSTAGLANDINS Patient Education Explain purpose of medication & vaginal exams May need to maintain bedrest while medication is absorbed Advise patient to notify HCP if contractions become prolonged PAIN MANAGEMENT Pain Management Systemic Medications Also includes adjunctive therapy Regional Blocks General Anesthesia Pain Management Goal of Pain Management During Labor Reduce perception of pain to facilitate healthy delivery Goal of Adjunctive Medications in Labor Decrease anxiety Relieve nausea and vomiting Help woman cope with labor pains Sedation Pain Management OPIOIDS Meperidine (Demerol) Fentanyl (Sublimaze) Nalbuphine (Nubain) Adjunct Medications Promethazine (Phenergan) Benzodiazepines Regional Blocks Epidural Pudendal Pain Management OPIOIDS Purpose Reduce perception of pain without loss of consciousness Drug of Choice Pure opioid agonists Mixed opioid agonist & antagonist Mechanism of Action Acts as CNS depressant at subcortical level Pain Management OPIOIDS Side Effects Hypotension Dizziness Sedation Nausea and vomiting Pruritus Respiratory depression Pain Management OPIOIDS Nursing Implications Assess for sedation, drowsiness & oversedation Assess cervical & labor status prior to administration Implement safety precautions Side rails Bed in lowest position Call light within reach Must have naloxone (Narcan) available for opioid reversal Pain Management OPIOIDS Patient Education May cause drowsiness or dizziness Call nurse prior to ambulating Advise patient regarding potential side effects Pain Management REGIONAL BLOCKS Purpose Reduce perception of pain allows to participate in birthing process Administration Epidural block Pudendal block May be used intrapartum or for surgical procedures May be used for labor, delivery, or both Allows participation in birth process with good pain control “Pressure” vs. pain sensation Pain Management REGIONAL BLOCKS: EPIDURAL Catheter passed via needle Allows for continuous infusion or intermittent injection Optimal timing is individualized, but when the cervix is at least 4 cm during active labor Local anesthetic drugs combined with opioid analgesic Side Effects Hypotension Bladder distention Prolonged 2nd stage of labor Pain Management REGIONAL BLOCKS: EPIDURAL Nursing Implications Record baseline vital signs & FHR pattern prior to start of epidural & frequently thereafter Support patient in the correct position during placement Palpate bladder to determine retention & distention Educate patient regarding safety Pain Management REGIONAL BLOCKS: PUDENDAL Injected near pudendal nerves Anesthetizes lower vagina & part of perineum Vaginal birth Episiotomy Forceps Possible Complications Hematoma Abscess is rare Pain Management GENERAL ANESTHESIA  Purpose Systemic pain control with loss of consciousness Cesarean delivery Surgical procedure Trauma or emergency Possible Complications Maternal Aspiration of gastric contents Fetal Respiratory depression Check on Learning The newborn of a woman who receives narcotic analgesics during labor should be observed primarily for ____________. a. b. c. d. Convulsions Slow respirations Excess activity constipation Check on Learning An advantage of an epidural block is that it ______________. a. b. c. d. Reduces pain for both labor and birth Has no fetal or maternal risks Supports normal blood pressure Enhances the woman’s urge to push Check on Learning A woman who is 2 hours postpartum after an uncomplicated birth wants to go to the bathroom to urinate. She had an epidural block for pain relief during labor and the medications and catheter for the block were removed immediately after birth. The infant has been nursing at intervals and the mother has eaten a light meal. a. Should you allow her to use the bathroom or have her use a bedpan? Explain your choice. b. If you allow her to walk to the bathroom, describe what you should do to ensure her safety. Enabling Learning Objective: C Identify pharmacological management during the postpartum period for a postpartum mother and the newborn. Immune Therapy Rh(D) Immunoglobulin (RhoGAM) Mechanism of Action Suppresses immune response of patient exposed to Rh+ blood Use Rh- women; prevent isoimmunization Blood incompatible with Rh+ newborn Immune Therapy Rh(D) Immunoglobulin (RhoGAM) Adverse Effects Acute respiratory distress, anaphylaxis, pulmonary, edema, DIC Nursing Implications Assess for allergies Type blood of mother and cord Patient Teaching Explain this medication must be given after subsequent babies Immune Therapy Rubella Mechanism of Action Promotes active immunity Induces the production of virus specific immunoglobulin G and M antibodies Use Prevention of infection with rubella virus Adverse Effects Fever Soreness at injection site Rash Postpartum Complications Acetaminophen (Tylenol) Mechanism of Action Reduce the production of prostaglandins Use To manage mild to moderate pain Adverse Effects Liver damage (if taken in large amounts) Maximum dose – 4 grams per day Postpartum Complications Acetaminophen (Tylenol) Nursing Implications Assess for pain Instruct patient on risks Patient Teaching Take as prescribed Advise patient to monitor OTC medications for acetaminophen Postpartum Complications Hydromorphone/acetaminophen (Norco/Vicodin) Mechanism of Action Bind to receptor site to alter perception of pain Use Manage moderate to severe acute pain Adverse Effects Respiratory depression Severe hypotension Decreased urine output Postpartum Complications Hydromorphone/acetaminophen (Norco/Vicodin) Nursing Implications Assess patient’s pain If breastfeeding, explain timing for administration Evaluate effectiveness of medication Patient Teaching Change positions slowly Impaired judgement is possible with administration Take with food Report constipation Check on Learning RhoGAM is given to pregnant women who are __________ to prevent isoimmunization. a. b. c. d. Rh+ Rh36 weeks pregnant 40 weeks pregnant Drugs to Treat Constipation Docusate sodium (Colace) Docusate calcium (Surfak) Mechanism of Action Lower surface tension of stool Allows for easier passage of stool Increases bulk and consistency (used for patients with watery diarrhea) Use Softening stool Adverse Effects Abdominal cramping Nausea Throat irritation Diarrhea Drugs to Treat Constipation Docusate sodium (Colace) Docusate calcium (Surfak) Nursing Implications Not a substitute for adequate hydration and nutrition Encourage patient to eat fruits and vegetables daily Patient Teaching Changes in color of urine Medications typically take 1-3 days to take effect These medications do not treat acute constipation Teach good bowel habits Drugs to Treat Constipation Bisacodyl (Dulcolax) Mechanism of Action Stimulates peristalsis Increase fluid in the intestine Relaxes the bowel to ease passage of stool Use Rapid relief of constipation Acute constipation Drugs to Treat Constipation Bisacodyl (Dulcolax) Adverse Effects Abdominal cramps Diarrhea Hypokalemia Muscle weakness Nursing Implications Inform patient that onset 6-12 hours Overuse may cause fluid/electrolyte imbalance Teach patient – laxatives are intended for short-term use Check on Learning Medications that can be given to a mother experiencing severe pain from a cesarean section wound would include the following ____________. a. b. c. d. Acetaminophen (Tylenol) Hydrocodone/acetaminophen (Norco) Oxytocin (Pitocin) RhoGAM Check on Learning Which of the following is a common side effect of docusate? a. b. c. d. Increase urine output Elevated blood pressure Depressed reflexes Diarrhea Prophylactic Anti-infective Agents Erythromycin Ointment Mechanism of Action Protein synthesis inhibitor – interfere with bacterial process Use Administered to newborn Prevention of Neisseria gonorrhea and chlamydia Adverse Effects Hypersensitivity Irritation Redness Drug to Assist the Newborn with Blood Clotting Vitamin K (AquaMEPHYTON) Mechanism of Action Assist the liver for formation of clotting factors Exact mechanism is unknown Use Production of Vitamin K is absent in newborn Given in single dose before infant leaves delivery room Adverse Effects Flushing dizziness Hypotension Pain at injection site Drug to Assist the Newborn with Blood Clotting Vitamin K (AquaMEPHYTON) Nursing Implications Inject into vastus lateralis Administer after the first hour of life Teach patients the reason for the Vitamin K injection Check on Learning They erythromycin ophthalmic ointment is given to all newborns shortly after birth to prevent ___________. a. b. c. d. Hemorrhagic disorders Bonding dysphoria Ophthalmic neonatorum Hepatitis A Check on Learning Administration of medications after birth is the topic of discussion during a prenatal education class. Which statement indicates to the nurse that the pregnant patient understands the primary indication of the administration of Vitamin K? (Select all that apply) a. “The nurse will draw blood to determine if vitamin K is needed.” b. “Vitamin K prevents the possibility of bleeding problems in my baby.” c. “My baby will receive a shot when the nurse administers the Vitamin K.” d. “Vitamin K will be administered shortly after birth, generally within the first hour.” Review of Main Points A. Antepartum medications B. Intrapartum medications C. Postpartum medications for mother and newborn Questions?