MED LIST labor and delivery Flashcards
Betamethasone
Corticosteroid,
Acceleration of fetal lung maturity Decrease severity of respiratory distress syndrome. 24-37 weeks.
can reduce incidence of intraventricular hemorrhage/ neonatal death in premature babies.
Requires a 24-hr period to be effective.
Betamthasone route
IM in two injections, gluteal muscle
24 and 48 hr prior to birth of a preterm neonate.
Betamethasone nursing considerations
Nursing pulmonary edema by assessing lung sounds and maternal and neonate hyperglycemia.
-Monitor the neonate for heart rate changes.
-Mom may have temporary increase in platelet and WBC count for up to 72 hrs (WBC > 20000/mm3 may indicate infection
Do not give if mom has an active infection
Betamethasone
2 injections of 12mg of the medicine 24 hours apart.
Magnesium sulfate
Anticonvulsant/Tocolytic
suppresses contractions.
Also used in patients with severe preeclampsia for seizure prophylaxis
Magnesium sulfate dosage/route
Loading dose: 4-6g in 100ml of IV fluid over 15-20 minutes, continued infusion @ 2 g/hr. Doses individualized as needed. May be given IM but is painful.
Magnesium sulfate nursing considerations
Monitor the client closely.
discontinued immediately if the client:
exhibits manifestations of pulmonary edema, which includes chest pain, shortness of breath, respiratory distress, audible wheezing and crackles, and/or a productive cough containing blood-tinged sputum.
Can cause postpartum hemorrhage
Magnesium sulfate patient education
Instruct the client to notify the nurse of blurred vision, headache, nausea, vomiting, or difficulty breathing.
Magnesium sulfate contraindications
active vaginal bleeding, dilation of the cervix greater than 6 cm, acute fetal distress. greater than 34 weeks of gestation, chorioamnionitis,
Magnesium sulfate toxicity
loss of deep tendon reflexes, urinary output less than 30 mL/hr, respiratory depression less than 12/min, pulmonary edema, and/or chest pain.
Calcium Glutinate
antidote for magnesium sulfate toxicity.- Keep at bedside as antidote when administering Magnesium Sulfate.
Caclium Gloconate effects on mother and fetus
May cause headache, tingling sensations constipation, nausea, vomiting, and hypercalciuria. Rapid IV injection of calcium salts may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias, syncope and cardiac arrest.
RhoD immuboglobulin/Rhogam Use
suppress the maternal immune response to fetal Rh-positive blood
Rh-negative client at 28 weeks of gestation or
72 hr to women who are Rh-negative and gave birth to infants who are Rh-positive to prevent sensitization in future pregnancies. administered IM within 72 hr of the newborn being born
to suppress antibody formation in the mother.
Rhogam Admin/RhoD immunoglobulin dose
Standard dose: 300mcg, IM in deltoid muscle
Vitamin K Use
Prevention or treatment of vitamin K-dependent bleeding
IM within 1 hour of birth for prophylaxis.
Erythromycin Ophthalmic Ointment
Prophylaxis against Neisseria gonorrhoeae, Chlamydia trachomatis; helps prevent ophthalmia neonatorum in infant of mothers infected with gonorrhea and conjunctivitis in infants of mothers infected with Chlamydia.
Erythromycin Ophthalmic Ointment Admin
- Clean baby’s eyes before applying.
- Be careful not to injure them with tube.
- Administer from the inner canthus to the outer canthus without touching the tip of the tube to the eye, as this may spread infectious material from one eye to the other.
- Watch for irritation.
- Use a new tube with each baby.
- Prophylaxis against gonorrhea required by law for all infants, even if mother is not known to be infected.
Oxytocin Use
Used to augment or induce uterine contractions and expulsethe products of conception.
Oxytocin is not administered for hypertonic contractions.
Administered to augment or induce labor by increasing intensity and duration of contractions.
oxytocin side effects
Can cause hypertonic contractions
When to use oxytocin
Post trm pregnancy (beyond 42 weeks of gestation)
Dystocia (prolonged, difficult labor) due to inadequate uterine contractions.
Prolonged rupture of membranes predisposes the client and fetus to risk of infection.
Maternal medical complications
Rh-isoimmunization, Diabetes mellitus, Pulmonary disease, Gestational hypertension, Fetal demise, Chorioamnionitis
Oxytocin Nursing Considerations
Prior to the administration of oxytocin, it is essential that the nurse confirm that the fetus is engaged in the birth canal at a minimum of station 0.
assessments include maternal blood pressure, pulse, and
respirations every 30 min and with every change in dose.
Monitor FHR and contraction pattern every 15 min and with every change in dose.
Assess fluid intake and urinary output.
Use the infusion port closest to the client for administration. Oxytocin should be connected “piggyback” to the main IV line and administered via an infusion pump.
Methergine (Methylergonovine Maleate)
Uterine stimulant- Controls postpartum hemorrhage
Methergine Nursing Considerations
DO NOT GIVE FOR PREGNANT PATIENT
Assess uterine tone and vaginal bleeding. Do not administer to clients who have hypertension
Monitor the client for adverse reactions including hypertension, nausea, vomiting, and headache
Methergine/methylergonovine dosage
0.2 mg IM q 2-4 hrs for up to 5 doses, then PO 0.2 mg q 6-8 hrs for up to 7 days. IV use not recommended; may cause severe hypertension
Procardia/Nifedipine
a calcium channel blocker that is used to suppress contractions by inhibiting calcium from entering smooth muscles.
Procardia Nursing Considerations
Monitor for headache, flushing, dizziness, and nausea. These usually are related to orthostatic hypotension that occurs with administration.
-Should not be administered concurrent with magnesium sulfate.
Procardia Teaching
Instruct the client to slowly change positions from supine to upright and to sit until dizziness disappears.
Inform the client to maintain adequate hydration to counter hypotension.
Procardia Dose
Oral loading dose of 30mg, then 10-20mg q 4-6 hours; use in monitored setting.
Procardia Side Effects
Flushing, light headedness, dizziness, headache, nausea, transient increase of maternal and FHR, mild hypotension, dysrhythmias, and edema.
Rubella Vaccine
Avoid Pregnancy 4+ weeks after recieving
Labetalol
Selective alpha and nonselective beta-adrenergic blocker, antihypertensive.
proper ADULT dose/route(s) of Labetalol
10 mg IVP over 1-2 mins. May repeat or double every 10 mins to a maximum dose of 150 mg. Infusion: 2-8 mg/min, titrated to supine blood pressure.
Labetalol side effects
Fatigue, weakness, depression, headache, dizziness, bronchospasm, wheezing, dyspnea, bradycardia, CHF, pulmonary edema, orthostatic hypotension, ventricular dysrhythmias, N/V, diarrhea.
dinoprostone/cervidil
prostaglandin/cervical ripening agent
Dinoprostone/cervidil use
assist in dilating the cervix
Cervidil/dinoprostone side effects
tachysystole, uterine hyperstimulation, fever
Cervidil/dinoprostone eduction
drug is not used for inducing labor but to prepare the cervix for labor
not given to women who have had 6+ children
hydralazine
recommended antihypertensive of first choice for severe hypertension in pregnancy
Butorphanol
Opiate agonist-antagonist
Butorphanol dose
1 to 4 mg
Terbutaline
Sympathomimetic (adrenergic) and tocolytic*
*tocolytic: any medication used to arrest uterine contractions. Often used to arrest premature labor contractions.
Terbutaline side effects
1) Palpitations
2) Tachycardia & PVC’s
3) Anxiety
4) Tremors
5) Headache
Terbutaline dose
Subcutaneous Injection: 0.25 mg may be repeated in 15-30 minutes
Carboprost
Prostaglandin, oxytocic.
Carboprost action
Stimulates contraction of the uterus.
Carboprost use
Used for the treatment of postpartum hemorrhage caused by uterine atony. Also used for abortion.
Carboprost dose and route
Postpartum hemorrhage: 250 micrograms intramuscularly. May repeat at 15- to 90-minute intervals. Maximum total dose 2 mg.
Misoprostol (Cytotec)
“Ripen” cervix
assess dilation and effacement of cervix
Misoprostol (Cytotec) dose and route
Vaginally 25 - 50 mcg. Q 6 hrs. Orally 25 - 50 mcg Q 6hrs may give up to four doses.
