Med Quiz I Flashcards
1
Q
oxytocin: classification
A
oxytoxic
2
Q
oxytocin: indications
A
- induction or augmentation of labor
- must have a favorable cervix (soft, go from posterior–>anterior position, dilate and efface)
- control of postpartum bleeding
- inevitable or incomplete abortion
- antepartum contraction stress test (CST): can help determine if the fetus can tolerate labor by getting 3 contractions in 10 min w/o any nonreassuring signs in FHR (negative–>continue pregnancy; positive–>deliver)
3
Q
oxytocin: action
A
- stimulates uterine smooth muscle resulting in inc strength, duration, and freq of uterine contractions
- vasoactive
- antidiuretic
4
Q
oxytocin: contraindications
A
- placenta previa
- vasa previa
- nonreassuring FHR
- abnormal fetal presentation
- prolapsed cord
- presenting part above pelvic inlet
- previous classic or fundal uterine incision
- active genital herpes
- pelvic structural deformities
- invasive cervical CA
5
Q
oxytocin: dosage for induction or augmentation of labor
A
- starting doses of 0.5 to 6 milliunits/min
- inc the dose to 1-2 milliunits/min every 15-40 min
- high dose protocols may inc dose in increments of up to 6 milliunits/min
- after adequate contraction pattern is established and cervix is dilated 5-6 cm, oxytocin may be reduced
- actual dose based on uterine response and absence of ADRs
6
Q
oxytocin: dosage for control of postpartum bleeding
A
- IV: 10-40 units at a rate of 20-40 milliunits/min
- inc or dec rate according to uterine response and rate of postpartum bleeding
- IM: 10 units after delivery of placenta
7
Q
oxytocin: dosage for inevitable or incomplete abortion
A
- 10 units at a rate of 10-20 milliunits/min
8
Q
oxytocin: ADRs
A
- hypertonic uterine activity
- impaired uterine bloodflow
- uterine rupture
- abruptio placentae
- fetal asphyxia (r/t diminished uterine blood flow)
- maternal fluid retention–>water intoxication
- hypotension
- tachycardia
- cardiac dysrhythmias
- subarachnoid hemorrhage
9
Q
oxytocin: nursing implications intrapartum
A
- assess fetal HR for at least 20 min before induction AND verify a cephalic fetal presentation w/ Leopold’s maneuver or a vaginal exam
- if nonreassuring FHR or non-cephalic, then do not begin induction until U/S is done
- observe uterine activity for establishment of effective labor pattern
- contraction every 2-3 min, duration of 40-90 sec, intensity of 50-80 mmHg
- watch for hypertonicity: contractions less than 2 min apart, rest interval shorter than 30 sec, duration longer than 90-120 sec, or resting tone greater than 20 mmHg
- if hypertonicity or nonreassuring FHR occurs, stop infusion, inc rate of nonadditive soln, position woman in side-lying, and administer O2 at 8-10 L/min
- given by pump
- titrated according to contraction pattern
- record BP, pulse, and RR every 30-60 min or with each dose inc
10
Q
oxytocin: nursing implications postpartum
A
- administer after delivery of the shoulders of the infant to help uterus contract
- observe uterus for firmness, height, and deviation
- massage until firm if uterus is boggy
- observe lochia for color, quantity, and presence of clots
- assess for cramping
- assess V/S every 15 min
- monitor I&O and breath sounds to identify fluid retention or bladder distention
- notify provider if uterus fails to remain contracted or lochia is bright red or has clots
11
Q
Misoprostol: Classification
A
prostaglandin E1 (PGE1) analog
12
Q
Misoprostol: indications
A
- cervical ripening
- make the cervix more favorable so you can administer oxytocin
- induction of labor
- termination of pregnancy
13
Q
Misoprostol: action
A
- causes uterine contractions
14
Q
Misoprostol: contraindications
A
- if you have risk factors for uterine rupture:
- late trimester pregnancy
- previous CS or uterine surgery
- >5 pregnancies
15
Q
Misoprostol: dosage
A
- 25 mcg vaginally
- must be prepared by pharmacist–broken from a 100 or 200 mcg tablet
- 100 mcg orally
16
Q
Misoprostol: ADRs
A
- uterine hyperstimulation
- contraindicated in a womean with previous cesarean or other uterine surgery
17
Q
Misoprostol: nursing implications
A
- to reduce leakage, have woman lie flat for 15-20 min after the gel form of PG is inserted
- FHR should be monitored for at least 30 min for changes
- uterus should be assessed for excessive contractions
- oxytocin induction can begin 4 hours after last dose
- if uterine hypertonicity occurs, place woman in side lying position, provide O2 at 8-10 L/min, administer tocolytic drug (terbutaline or Mg Sulfate)
18
Q
Dinoprostone: classification
A
cervical ripening agent
19
Q
Dinoprostone: indications
A
- cervical ripening
- make the cervix more favorable so you can administer oxytocin
20
Q
Dinoprostone: action
A
- Produces contractions
- Initiates softening, effacement, and dilation of the cervix
21
Q
Dinoprostone: contraindications
A
- PID
- ROM
- previous CS
- asthma
- HTN
- glaucoma
- severe renal or hepatic dysfunction
- ischemic heart dz
22
Q
Dinoprostone: dosage
A
- 10 mg in a time release vaginal insert left in place for up to 12 hours
- remove w/ onset of active labor, membrane rupture, or uterine hyperstimulation
23
Q
Dinoprostone: ADRs
A
- hypertonic contractions (uterine hypertonicity)
- amniotic fluid embolism
- uterine rupture
24
Q
Dinoprostone: nursing implications
A
- remove after 12 hours or when active labor begins
- ADRs can be reduced w/in 15 min after removal
- if hypertonic uterine activity occurs, remove insert, place woman in side lying position, provide O2 at 8-10 L/min, and administer tocolytic (terbutaline or Mg sulfate)
- may occur up to 9.5 hours after placement
- to reduce leakage, have woman lie down for 2 hours after insertion
- oxytocin induction may begin 30-60 min after removal of insert
25
Butorphanol tartrate: classification
opioid analgesic
26
butorphanol tartrate: indications
* systemic pain relief during labor
27
Butorphanol tartrate: action
* MOA unknown
* has agonist antagonist effects
28
Butorphanol tartrate: contraindications
* opiate dependence
* use cautiously w/ preterm births
29
butorphanol tartrate: dosage
* IV: 1 mg every 3-4 hour
* range 0.5-2 mg
30
butorphanol tartrate: ADRs
* respiratory depression or apnea (in woman or fetus)
* anaphylaxis
* dizziness, lightheadedness, sedation, lethargy, HA, euphoria, mental clouding, fainting, tremors, delirium, insomnia
* n/v/constipation/anorexia
* dry mouth
* flushing
* altered HR and BP
* circulatory collapse
* urinary retention
* sensitivity to cold
31
butorphanol tartrate: nursing implications
* assess for allergies and opiate dependence
* administer at the beginning or peak of contraction in order to prevent a lot of med going to baby
* observe V/S and respiratory fcn in woman (at least 12 breaths/min) and newborn (at least 30 breaths/min)
* have naloxone and resuscitation equipment available
* report n/v for an order for antiemetic
* may enhance respiratory depression
32
Fentanyl: classification (p.291)
* opioid analgesic
33
Fentanyl: indications
* intrapartum pain management
* opioid analgesics
* used as an _adjunct_ to epidural analgesia
34
Fentanyl: action
* Binds to opiate receptors in the CNS, altering the response to and perception of pain.
* Produces CNS depression.
35
Fentanyl: contraindications
* opiate dependence
36
Fentanyl: dosage
* 50-100 mcg
* may be repeated every hour
* may be given by PCA
37
Fentanyl: ADRs
* pruritis
* n/v
* delayed respiratory depression: for up to 12 hr after administration
38
Fentanyl: nursing implications
* record baseline maternal V/S and FHR
* nurse should observe for signs of subarachnoid puncture or intravascular injection
* assess maternal BP and FHR every 5 min furing first 15 min after administration
* repeat at 30 min and at 1 hour after procedure
* assess bladder every 2 hour
* may need to obtain order for catheter placement
* observe neonate for respiratory depression (esp if drug given w/in 4 hours of birth)
* can use adjunctive therapy for nausea (promethazine)
* have naloxone and respiratory resuscitation equipment ready
39
Bupivicaine: classification
* epidural local anesthetic
40
Bupivicaine: indications
* epidural block
* for intrapartum pain management
* local anesthetic: for episiotomy, to repair tear or laceration
41
Bupivicaine: action
* Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission.
42
Bupivicaine: contraindications
* coagulation defects
* uncorrected hypovolemia
* infection in area of insertion or systemic insertion
* allergy
* fetal condition that demands immediate birth
43
Bupivicaine: dosage
* 10-20 mL
* administer in increments of 3-5 mL
* do a test dose of 3 mL before full administration
44
Bupivicaine: ADRs
* maternal hypoTN
* bladder distention
* prolonged 2nd stage of labor
* epidural catheter migration
* cesarean births
* maternal fever
* can cause seizure if injected into vessel
45
Bupivicaine: nursing implications
* often times administered with epi to prevent bleeding
* record baseline maternal V/S and FHR
* nurse should observe for signs of subarachnoid puncture or intravascular injection
* assess maternal BP and FHR every 5 min furing first 15 min after administration
* repeat at 30 min and at 1 hour after procedure
* assess bladder every 2 hour and encourage mom to void
* may need to obtain order for catheter placement
* prehydrate woman with LR or NS
* displace uterus with wedge under woman's side to enhance placental perfusion
* assess FHR for signs of impaired placental perfusion
* if impaired placental perfusion or hypoTN occur: administer nonadditive IV fluid, reposition woman on side, administer 8-10 L/min of O2
