intrapartum medication Flashcards
Oxytocics stimulate contraction of the uterus and allows let down
Indications:
•labor induction
•augmentation of labor
•postpartum abbreviation of third stage of labor
•postpartum control of uterine bleeding (prevent hemorrhage)
•termination of pregnancy
•evaluation of fetal respiratory capability
Oxytocin (Pitocin)
Indirectly stimulates contraction of uterine smooth muscle by increasing the sodium permeability of uterine myofibrils.
•Increases contraction amplitude and frequency
•Oxytocin has specific receptors in the muscle lining of the uterus and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term.
•Contracts myoepithelialcells surrounding the alveoli of the breasts, forcing milk from the alveoli into the larger ducts and facilitating milk ejection.
•Minimal antidiuretic activity relative to vasopressin; water intoxication possible at high doses and/or excessive electrolyte-free fluid.
oxytocic medications
Uterine response after IV administration is immediate and subsides after 1 hour Metabolism: Hepatic and plasma Adverse Effects: • Uterine hyper tonicity and spasm • Tetanic contraction • Uterine rupture • Postpartum hemorrhage • Fetal hypoxia and arrhythmias • Maternal arrhythmias • N&V • Maternal water intoxication
Oxytocic meds continuted
• Check concentration carefully
• Assess FHT – If not reactive notify HCP
• Assess maternal VS, CNS status, LS, I&Os, bladder distention
• Assess cervix, presence of vaginal bleeding and BOW status
• Oxytocin must be piggybacked and on an infusion pump
• Assess patients understanding and obtain consent for procedure
• Nursing to Patient ratio 1:2 with induction/augmentation or 1:1
with high risk and active management
nursing actions of oxytocin
• Indications for induction or augmentation using oxytocin
• She will receive support throughout her labor
• Discuss contractions and pain control options
• Possible adverse effects
-Sharp, localized abdominal pain
-Bleeding (Frank)
-S/S of tetanic contractions
-Decreased or absent fetal movement
-SOB, cardiac palpitations
-Change in LOC
• Safety and comfort options available
• Discontinue Oxytocin if any s/s of maternal or fetal distress
Patient teaching for oxytocin
Indication: Local anesthetic (most commonly used)
• Inhibits nerve conduction through blockade of sodium channels resulting in slowed
conduction velocity. It prevents pain impulses from being created.
• Metabolism: Hepatic and excreted by Kidneys
• Adverse Effects:
-Cardiac arrhythmia
-Hematoma (bleeding in tissue and infection in peri area)
-Infection at injection site
• Nursing Actions:
-Check concentration carefully
-Patient teaching:
-Pain relief lasts approximately 2 hours
-Report pain, swelling at injection site
Lidocaine hydrochloride (Xylocaine HCl) Labor pain managment
• Drug class: Short acting opioid agonist narcotic
• It binds with opioid receptors (primarily CNS) resulting in anesthesia and sedation
• Metabolism: isoenzyme system (primarily protein synthesis)
• Adverse Effects:
-Sedation/dizziness, confusion, hallucinations
-Respiratory Depression/arrhythmia*
-N&V, constipation
-Narcotic intolerance and dependence
Fentanyl citrate (sublimaze) labor pain managment
• Nursing Actions:
-Monitor CNS, cardiac and respiratory status closely
-Administer slowly over at least one minutes usually into running IV
-Initiate modified fall precautions
-Keep opioid antagonist nearby if delivery imminent
Patient teaching:
-Pain relief lasts approximately 1 hours
-Neonates may experience sedation after birth
Fentanyl citrate (sublimaze) labor pain management (2)
Drug class: Short acting opioid agonist-antagonist narcotic
• It interacts with an opiate receptor sites in the CNS
• Metabolism: Hepatic
• Adverse Effects:
-Sedation/dizziness, confusion, hallucinations
-Respiratory Depression/arrhythmia – most frequent is hypotension
-N&V, dry mouth
-Narcotic intolerance and dependence
•
Butorphanol tartrate (Stadol) Labor pain management
Nursing Actions:
• Monitor CNS, cardiac and respiratory status closely
• Administer slowly over at least 3-5 minutes usually into running IV
• Initiate modified fall precautions
• Keep opioid antagonist nearby if delivery imminent
• Neonates may experience sedation after birth especially cardiac
Patient teaching:
• Pain relief lasts approximately 2-3 hours
Butorphanol tartrate (Stadol) Labor pain management (2)
Drug class: Anesthetic Agent
• Blocks the generation and the conduction of nerve impulses and prevents depolarization of
nerve cells
• Clinically, the order of loss of nerve function is as follows: (1) pain, (2) temperature, (3) touch,
(4) proprioception, and (5) skeletal muscle
• Metabolism: Hepatic
• Adverse Effects:
• Headache, anxiety, tinnitus, blurred vision, or tremors, seizures
• Respiratory and Cardiac Depression
• Peripheral vasodilation and arrhythmias, urinary incontinence/retention, pruritus
bupivacaine (Marcaine)
Nursing Actions:
• Monitor CNS, cardiac and respiratory status closely
• The patient should have IV fluids running via an indwelling catheter to assure a functioning
intravenous pathway
• Monitor skin integrity and bladder distention
Patient teaching:
• Pain relief lasts approximately 1-2 hours after infusion is stopped
bupivacaine (Marcaine) (2)
- Headache, anxiety, tinnitus, blurred vision, or tremors, seizures
- Respiratory and Cardiac Depression
- Peripheral vasodilation and arrhythmias, urinary incontinence/retention, pruritus
adverse effects of bupivacaine (Marcaine)
Drug class: morphinans, Opioid agonist analgesic - derivative of morphine that acts
as a narcotic analgesic
• It interacts with an opiate receptor sites in the CNS for analgesia and sedation.
Approximately 8 times more potent than morphine
• Metabolism: Hepatic, excreted renally
hydromorphone hydrochloride (Dilaudid)
• Respiratory and Cardiac Depression
• light-headedness, dizziness, sedation, nausea, vomiting, sweating, flushing,
dysphoria, euphoria, dry mouth, and pruritus, GI distress/constipation
adverse effects of hydromorphone hydrochloride (Dilaudid)
