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0
Q

Terbutaline

-route and dosage

A

IV, PO, Subq

IV: begin at .01-.05mg/min increase by .01 mg/min until contractions or max dose of .08mg/min . Maintain for 1 hr. Then reduce in 20 min intervals to minimum maintence dose when contractions stop. Continue for 12 hrs

Subq: intermittent inj. .25 mg Q4hr

PO: 2.5-5mg Q2-4hr.. Give first oral dose 30 min before IV discontinuation

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1
Q

Terbutaline

  • class
  • action
  • indication
A

Beta adrenergic
Block action in sympathetic nervous system resulting in reduced blood vessel contraction
Tocolysis to stop PTL

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2
Q

Terbutaline

  • side effects
  • antidote
A

Maternal and fetal tachycardia
Maternal: hypotension, dysrhythmias, pulmonary edema, Hypokalemia, hyperglycemia, restlessness, tremors, chest pain

Propranolol (inderal)

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3
Q

Terbutaline

- nursing assessments

A

Assess maternal apical HR and lung sounds before each dose
HR greater than 120 bpm and wet lung sounds, increase in Respirations, SOB, may be reason to discontinue therapy and should be reported promptly

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4
Q

Terbutaline

- other names

A

Brethine

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5
Q

Narcan
-class
Action
Indication

A

Opiate antagonist
Reverses CNS and respiratory depression caused by narcotics . Competes with narcotics @receptor sites

Severe respiratory depression in newborn when mother has received narcotics within 4hrs of birth . Reduce pruritis from epidural opioids

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6
Q

Narcan
-route
Dosage

A

IV, IM, Subq, endotracheal tube

Adult resuscitation 0.4-2mg IV
Pruritis 0.04-2 mg IV
Neonate resuscitation 0.1mg/kg IV

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7
Q

Narcan
-side effects
Contraindications

A

Use with caution if mother is addicted to opiates, will cause withdrawal symptoms and maybe seizures

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8
Q

Narcan

Considerations

A

Prepare syringe before birth if depression from opiates is expected, draw up more than what is needed and then prepare according to weight . Monitor response and be prepare to give repeated dose if necessary

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9
Q

Narcan

-other names

A

Naloxone hydrochloride

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10
Q

HBIG

  • use
  • other names
A

To prevent chronic infection of a newborn whose mother is HBsAg- positive (HBV infection)

Hepatitis B immune globulin, Hep-B-Gamma-gee

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11
Q

HBIG
Maternal considerations
Fetal considerations

A

Maternal: vaccine should be offered if mother has risk factors , all women should be screened for HBV

Fetal: give 1st dose within 12 hrs of birth if mother is positive . Infant test 1-3 mo. After completing series for chronic infection

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12
Q

HBIG

Dosage route

A

1st dose- before discharge
2nd dose- 2 mo.
3rd dose- 6to18mo.
Route: intramuscular

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13
Q

HBIG

Nursing considerations

A

Teach preventable measures to reduce risk: hand washing, standard precautions with body fluids, safe sex

Clean newborn skin before injection to prevent contamination from maternal blood.

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14
Q

Methergine
-class
Action
Indication

A

Ergot alkaloid , uterine stimulant

Action: stimulates sustained contractions of the uterus and causes arterial vasoconstriction

Indication: used for prevention and treatment of postpartum or post abortion hemorrhage caused by uterine atony or subinvolution

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15
Q

Methergine

  • dose
  • route
A

0.2 mg IM Q2-4H, max of 5 doses
Oral: 0.2mg Q6-8hrs for max of 7 days
IV: life threatening situations only, given over 60 sec. ( monitor BP)

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16
Q

Methergine
-contraindications
Side effects

A

Never use during pregnancy / to induce labor , hypersensitivity to ergot, hypertension, hepatic/renal disease, CAD, PVD, ….

Cramping, dizziness, dyspnes, n/v, chest pain, seizure

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17
Q

Methergine

  • nursing considerations
  • other names
A

Monitor BP ( elevates) , assess before administration for baseline , avoid smoking

Methylergonovine

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18
Q 
Hemabate 
-class
Action
Indication 
Other names
A

Class: prostaglandin , oxytocic
Action: stimulates contraction of the uterus
Used to treat postpartum hemorrhage caused by uterine atony. Abortion

Carboprost Tromethamine, Prostin/15M

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19
Q

Hemabate

Route/dosage

A

IM

Postpartum hemorrhage: 250 mcg may repeat in 15-90 min intervals / max dose 2 mg

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20
Q

Hemabate
- contraindications
Side effects

A

Acute pelvic inflammatory disease, cardiac, pulmonary, renal, hepatic disease .

Adverse: fever, chills, flushing, headache, hypertension, hypotension, tachycardia, pulmonary edema

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21
Q

Hemabate

Considerations

A

Administer IM, rotate sites . Monitor vitals . Administer antiemetics/ anti diarrheal as ordered

22
Q

Cytotec

-class
Indication
Other names

A

Prostaglandin
Preinduction cervical ripening and labor induction
Misoprostol

23
Q

Cytotec

-dosage /route

A

1/4 of a 100 mcg tab vaginally (25mcg)

Labor: repeat 25 mcg Q3-6hr

24
Cytotec - side effects - antidote
Tachysystole ( can reduce placental blood flow and fetal oxygen exchange Place women in side lying position. Oxygen 8-10L/min administer tocolytic drug ( terbutaline, mag. Sulfate)
25
Cytotec | - considerations
Monitor FHR and uterine activity for baseline and 30 min after Non reassuring HR and excessive contractions usually develop within first hour
26
Ilotycin -class Action Indication
Antibiotic Inhibits protein synthesis in bacteria Prophylactic eye treatment to help prevent ophthalmia neonatorum . Prophylaxis against Neisseria gonorrhoeae. Treatment required by law for all newborns
27
Ilotycin Dose /route
0.5% of ointment 1cm long, placed in lower conjunctival sac of each eye within 1 hr of birth
28
Ilotycin Side effects Considerations
Mild inflammation, burining, itching, blurred vision, Cleanse eyes as ordered before application, wipe from inner to outer, avoid pressure on eye itself, do not rinse, excess ointment can be wiped after 1 min. Use new tube for each infant. Observe for discharge, if purulent may indicate infection
29
Hep B vaccine - class - other names - indication
Vaccination Recombivax-HB, Engerix-B Prevent chronic infection of newborn whose mother is HBsAG-positive . Administered with the HBiG vaccination within 12 hrs of birth
30
``` Nubain -class Action Use Other names ```
Class: opioid analgesic Action: binds to opiate receptors Use: decrease pain related to labor Nalbuphine
31
Nubain - CI Side effects Antidote
CI: patient is dependent on opiates, and has not be detoxified because it may precipitate withdrawal N/v, pruritis , respiratory depression, dizziness, confusion, dry mouth, clammy skin Narcan
32
Nubain | - dose/route
10-20 mg q3-6hr IV , may be given by PCA
33
Nubain -considerations
Record maternal and fetal baselines before and after administration Monitor for respiratory depression , don't give to opiate dependent pts
34
``` Fentanyl -class Action Use Other names ```
Class: opiod agonist Action: decrease pain r/t labor Adjunct to epidural analgesia during labor/pain Sublimaze
35
Fentanyl -CI Side effects
Use with caution in pregnancy and lactation. | Respiratory depression
36
Fentanyl Dose/route
20-50 mcg IV . May repeat 8hr , can be give over PCA
37
Fentanyl Considerations
Record baseline maternal and fetal vitals | Monitor pain and for respiratory depression
38
``` Vitamin K - class Action Indication Other names ```
- fat soluable vitamin, antihemorrhagic - promotes formation of factor II ( prothrombin) , VII, IX, X, by the liver , for clotting. Provides vitamin K, which is not yet synthesized , until intestinal flora is established. - prevention/ treatment of vitamin K deficiency bleeding - aquamephyton, konakion, mephyton
39
Vitamin K - route/ dose - adverse reactions - nursing considerations
- 0.5-1mg given once IM within 1 hr of birth - erythema, pain, edema at injection site. Hemolysis, hyperbilirubinemia - observe infant for signs of vitamin deficiency ( eccymosis, bleeding) check to see if administration is done before circumcision. Administration can be delayed until after first breast feeding
40
Myticon - class - action - indication - other names
- antiflatulent - causes the coalescence of gas bubbles. Passage of gas through GI tract - relief of painful symptoms of excess gas in GI tract - Simethicone, gas relief, flatulex, infacol, ovol, pediacol, gas-x
41
Myticon -route / dosage Contraindications Nursing considerations
- 20 mg X4 day (max 240mg/day) PO infant 40-125 mg QID, after meals and bedtime (max500 mg/day) adult - infant colic, abdominal pain from unknown cause w/fever - assess abdominal pain, distention, and bowel sounds. Monitor for gas passage, can be mixed with 30 mL of formula
42
Norco - class - action - indication - other names
- opioid agonist/nonopioid analgesic - binds to opiate receptors in the CNS . Decrease severity of moderate pain - management of moderate to severe pain - hydrocodone/ acetaminophen , anexsia, lortab, Vicodin, zydone , co-gesic
43
``` Norco -route/dosage Contraindications Side effects Interactions Antidote ```
- 2.5-10 mg Q3-6 hrs (do not exceed 4g/ day of acetaminophen) PO - avoid chronic use during lactation, severe hepatic, renal disease - confusion, sedation, respiratory depression, hypotension, urinary retention, OH, - MAO inhibitors - Naloxone
44
Norco | - nursing considerations
``` Assess vitals before and during therapy Monitor for respiratory depression Assess LOC Assess bowel functions Caution and teach patient to call for assistance when ambulating due to OH. ```
45
Motrin - class - action - indication - other names
- nonopioid analgesic , antipyretic, anti inflammatory - inhibits prostaglandin synthesis. Decreases pain and inflammation. - treatment of mild to moderate pain, fever, - Ibuprofen, Advil, midol, nuprin, pediacare
46
Motrin | -route/dosage
- PO adult analgesia : 200-400 Q4-6hrs (max 1200mg/day) PO infant analgesia : 4-10 /kg/dose Q6-8 hrs "" antipyretic : 5 mg/kg for temp anti inflammatory 30-50 mg/kg / day in 3-4 doses
47
Motrin - contraindications Side effects Considerations
Avoid after 30 weeks gestation . Use cautiously during lactation Headache, GI bleed, anaphylaxis , n/v Assess for GI bleeding, assess pain, monitor temp.
48
Stadol - class - action - indication - other names
- opioid agonist/ antagonist - binds to opiate receptors in CNS , alters perception to pain. Has partial antagonist properties that may cause withdrawal symptoms in opiate dependent pts. - labor pain - butorphanol
49
Stadol - route/dosage - contraindications - side effects - antidote
- 1-2 mg Q3-4 hr, range 0.5-2 mg IV, may be given by PCA - pt physically dependent on opiates - respiratory depression, hypotension, sweating - Narcan
50
Stadol | -considerations
Can cause respiratory depression in neonate, have Narcan ready. Assess vitals, encourage pt. to change positions slowly due to OH
51
RhoGAM - class - action - indication - other names
-concentrated immunoglobins directed toward RBC antigen Rh D -prevents production of anti Rh D antibodies in Rh- negative women who have been exposed to Rh-positive blood by suppressing the immune reaction . Prevents hemolytic disease in newborns -delivering/aborting Rh- positive fetus , transfusion of Rh- positive blood, choric villus sampling , amniocentesis , intraabdominal trauma -Rh D immune Globin, Gamulin Rh
52
RhoGaM - dosage/route - CI - side effects - considerations
- IM standard dose @ 28 weeks and within 72 hrs of delivery . Within 72 hours following termination of 13 weeks or more. One microdose within 72 hrs of termination of 13 weeks or less . - Rh - positive status , previous sensitization - fever, local pain at injection site - deltoid recommend site,

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