Medications Flashcards
morphine sulfate
- opioid
- s/e resp depression
- cautious in 2nd stage
- used during labor
butorphanol
opioid agonist-antagonist
- 2-4mg IM, .5-2mg IV
- s/e no resp depress in mom + bb
- dont give to drug dependent woman>possible suddent withdrawal of bb or mom
nalbuphine (Nubain)
opioid agonist-antagonist
- 10mg IM or IV
- s/e no resp depress in mom + bb
- dont give to drug dependent woman>possible suddent withdrawal of bb or mom
sublimaze (Fentanyl)
short acting opioid
- 50-100 mg IM, 25-50 mg IM
- s/e cross placent, synth opioid, FHR changes, hypotension, mom/bb CNS depress, resp depress
- monitor s/e like sedation, n/v, itch, resp effort
local anesthesia used during labor is given during ____ for ____but puts mom at risk for _____ so monitor _____
> 2nd stage of labor or immediately before delivery
anesthesize episiotomy/repair
risk for hematoma/infection
monitor returnof sensation or incr swellign at injection site
pudendal block
anesthetic injected to pudendal nerve close to ischial spine via trumpet needle
pudendal block is admin during ____ for ____
2nd stage or before labor
>to anesthesize vulva, lower vagina, part of perineum, or to use low forceps
pudendal block risks + nursing implicaitons
toxicity, hematoma, infection
monitor for retun of sensation, s/s infection, urinary retension
epidural block
anesthetic injected to epidural space
- outside of dura bw dura + spinal canal
- bw 4th -5th vertebrae
via epidural catheter
when is epidural given
1st or 2nd stage of labor
- for both vaginal + c section
- potl for 100% block of pain
- can be used w opioids like sublimaze to allow walking + effective pushing
epidural adverse effects
hypotension is most common
- n/v
- pruritis
- resp depress
- alt FHR
- decr mom hypervent
- reduced sweat
- alt thermoregulatory
pre-epidural care
-assess pain lvl
-contact HCP is epidural is requested
-assess/doc baseline VS
-assess/confirm norm FHR
obtain consent
-check lab val esp bleeding/clotting
-IV bolus w norm saline or lactated ringer
-ensure emergency equipment is available
do time-out procedure verification
walking epidural
combined spinal epidural analgesia
-injection into subarachnoid space
do nurses manage the care of pt receiving epidural?
no, they can monitor, but DO NOT MANAGE
actions OUTSIDE of nursing scope re epidural
- managing care
- dosing, cont infusion
- insertion, injection, manage rate changes
responsibilities of nurses caring for epidural pt
- monitor stable VS, mobility, LOC, pain perception, fetal status
- assess, monitor + intervene
during epidural care
-assist anesthesia provider w placement of pt in lateral position w head flexed towards chin or sitting w head flexed + elbows on knees
nursing care after epidural
- VS + FHR Q5-15min
- assess hypotension or resp depress
- assess level of motor blockage
- monitor for s/s of intravascular injection
s/s of intravascular injection
- occurs during placement
- tachy/bradycardia
- HTN
- dizzy
- tinnitus
- metallic taste
- loss of consciousness
folic acid for chilbearing age
0.4-0.8 mg
folic acid for pregnancy W/O hx of NTD
0.6 mg
folic acid for women w hx of NTD
4mg for 1st month,
>then .4mg
prenatal vitamins
- calcium
- magnesium
- vitamin D
- iron
terbutaline indication + MOA
- decr UC + delay delivery
- beta adrenergic agonist> relax smooth muscles
terbutaline CI + SE
CI: arrythmia, pulmo edema, MI, hypotn
SE: tremor, tachy, anxiety
procardia inidcation + MOA
- decr UC
- blcks Ca fr entering smooth muscle> relaxed uterus
procardia CI + SE
CI: cardiac disease, renal disease, hypotension
SE: headache, flushing, dizzy
oxytocin indication + MOA
-prevent PPH after placental expulsion, mgmt of 3rd stage labor
MOA: stim UC
methergine indication + MOA
- prevent PPH; for uterine atony
- ergot alkaloid act on smooth muscles to stimulate contraction
methergine CI
HTN, heart problems
hemabate indication + MOA
for uterine atony
-prostaglandin> stim smooth muscle contraction
hemabate CI
asthma
