Sim Lab Medications Flashcards
Uses of pitocin
Induction/augmentation of labor
PPH
Route for pitocin used for labor induction/augmentation
IV titration
Route used for pitocin for PPH
IV bolus
IM injection
Action of pitocin
Stimulates uterine smooth muscle, resulting in increased strength, duration, and frequency of contractions
Vasoactive and anti diuretic properties
Side effects of pitocin for mother
*Water intoxication
Tachysystole
Impaired uterine blood flow
Fetal asphyxia
Uterine rupture
Side effects of pitocin for fetus
Bradycardia
Tachycardia
Reduced variability
Late or prolonged decels
Nursing responsibilities for pitocin given for induction/augmentation
Assess contractions and VS every 15 min
Assess FHR before induction and every 15 min during
Monitor for water intoxication
Monitor I&Os
Stop infusion if:
- contractions <2 min apart and >50-65 sec or if they last longer than 60-90 seconds
- fetal distress
Symptoms of water intoxication
Drowsiness
Listlessness
Confusion
HA
Anura
Nursing responsibilities for pitocin given PP
Monitor uterine height, tone, deviation
Monitor lochia flow
Monitor VS
Patient teaching for pitocin given for induction/augmentation
Expect cramping similar to menstrual cramps that gradually increase in intensity and become strong
Report increased abdominal pain, blood loss, or fever
Patient teaching for pitocin given PP
Report boggy uterus or increase in lochia flow
Teach pt to massage their fundus
Preferred route for methergine
IM for rapid absorption
Use of methergine
Treat/prevent PPH (or post abortion hemorrhage) caused by uterine agony or subinvolution
Action of methergine
Stimulates sustained contraction of the uterus and causes arterial vasoconstriction
Side effects of methergine
*Hypertension
N/V
Uterine cramping
Dyspnea
Dysrhythmias
Nursing responsibilities for methergine
Use caution in pts with HTN and cardiac disease
Nicotine causes vasoconstriction and cannot be used with methergine
Monitor BP/VS (*check BP prior to each dose)
Monitor vaginal bleeding, uterine tone, height of fundus
Patient teaching for methergine
*Avoid smoking because nicotine constricts vessels
Abdominal cramps are a side effect
Notify prescriber if you have chest pain, N/V, HA, muscle pain, weakness, cold, numb extremities
Teach pt to massage fundus
Route for Hemabate
IM
Use of Hemabate
to treat PPH
Action of Hemabate
Stimulate contraction of the uterus
Maximum dose of methergine
Can be given every 2-4 hours for a maximum of 5 doses
Maximum dose of Hemabate
May repeat at 15 to 90 min intervals
Maximum total of 2 mg
Side effects of Hemabate
*Diarrhea
Titanic contractions and laceration of uterus or uterine rupture
Hypertension/hypotension
Nausea
Nursing responsibilities for Hemabate
*Administer anti diarrheal as ordered
*Monitor fundus and lochia
Should be refrigerated
Give via Deep IM injection
Rotate sites if repeated
Monitor vitals
Administer antiemetics as ordered
Patient teaching for Hemabate
Almost always causes diarrhea so we will admin antidiarrheal to avoid
Expect abdominal cramps similar to menstrual cramps
Change position slowly
Report any increase in vaginal bleeding
Routes for cytotec
PO
PR
PV
(Rectal preferred for PPH)
Uses for cytotec
Cervical ripening
Treatment of PPH
Action of cytotec
Induces uterine contractions
Ripens cervix, making it softer and causes it to begin to dilate and efface
Side effects of cytotec
Uterine cramping
Tachysystole
Uterine rupture
Diarrhea
Nausea/vomiting
Dyspepsia
Nursing responsibilities for cytotec
*NOT used in women with previous uterine scar
*DO NOT start pitocin for at least 4 hours after vaginal cytotec dose (for induction)
Monitor FHR, contraction pattern, cervical dilation/effacement
Patient teaching for cytotec
Lie flat for 30 min after insertion of medication (void prior to insertion)
Report contractions lasting > 1 min
Report any worsening or increase in vaginal bleeding
Route for terbutaline
SQ
When should terbutaline not be given?
If pulse is > 120
If systolic BP < 80-90
If FHR >180
Don’t use beyond 48-72 hours
Use of terbutaline
To stop preterm labor contractions
Action of terbutaline
Relaxes uterine smooth muscle by acting on beta2 receptors with less effect on the heart
Side effects of terbutaline
*Maternal and fetal tachycardia
Dyspnea
Palpitations
Chest pain/discomfort
Restlessness
Tremors
Flushing
Hypokalemia
Nursing responsibilities for terbutaline
What is the antidote?
Which pts should you use caution with?
Monitor VS/HR
Ensure inderal is available to reverse adverse effects
Caution in women with history of cardiac disease, gestational diabetes, severe gestational HTN, eclampsia
Monitor fetus, contraction pattern, dilation/effacement
Patient teaching for terbutaline
Inform her that she will hear baby’s HR increase on monitor and that this is expected
Limit caffeine
Drug is only administered in the hospital
Report if symptoms continue once you go home
What is the max dose of magnesium sulfate?
24 grams in 24 hours
Route for mag sulfate
IV
IM (rarely)
Use of mag sulfate
Prevent seizures
Treatment of preterm labor
Action of mag sulfate
Increases osmotic pressure, draws fluid into colon, neutralizes HCL
Plays important role in neurotransmission and muscular excitability
Side effects of magnesium sulfate on patient
Depression of DTR
CNS depression
Flushing/sweating
Hypotension
Respiratory depression
Side effects of magnesium sulfate on fetus
Reduced FHR variability
Hypotonia
Nursing responsibilities for mag sulfate
*Antidote = calcium gluconate (keep in room)
Monitor BP closely
Assess VS (RR should be > 12)
Monitor I&O (UOP should be > 30 mL/hr)
Monitor DTRs
Assess edema in LE
If preeclampsia - seizure precautions
Assess magnesium toxicity
Monitor Mg and Ca levels (therapeutic mag level: 4.8-8.4)
Symptoms of magnesium toxicity
Thirst
Confusion
Decreased DTR
Visual changes: blurring, halos
Patient teaching for magnesium sulfate
Med is given to delay preterm labor and prevent seizures associated with eclampsia
Need for frequent monitoring
Report SE (family or pt)
Side rails up
OOB with assistance
Route for Lebatalol
IV
PO
IM
Use of Lebatalol
Treat HTN during pregnancy
hypertensive emergencies
Reduces BP associated with preeclampsia/eclampsia and preserves uteroplacental blood flow
Action of Lebatalol
Produces decrease in BP without reflex tachycardia or significant reduction in HR through mixture of A and B blocking effects
Side effects of Lebatalol
Orthostatic hypotension
Flushing
Tremulousness
Minimal change in pulse rate
Nursing responsibilities for Lebatalol
Who is it contraindicated for?
Monitor VS
Maintain BR in left lateral position with SR up
Continuous fetal monitoring
Contraindicated in patients with asthma, heart disease, or CHF
Patient teaching for Lebatalol
Change positions slowly to prevent orthostatic hypotension
Explain need for BR and increased monitoring in labor
Explain why receiving medication and potential SE
If intrapartum, monitor BP, eat well, keep appointments
Route for vitamin k
IM in Vastus lateralis
Use for vitamin K
*Prevent hemorrhagic disease of the newborn
action of vitamin k
Provides vitamin k which is not synthesized in the intestine until flor is present for vitamin k production
Side effects of vitamin k
Pain
Edema or erythema at injection site
Hyperbilirubinemia
Hemolytic anemia
Bronchospasm
Respiratory arrest
Nursing responsibilities for vitamin k
*Give within 2 hours of birth
*Give prior to circumcision
Protect drug from light until ready to give
Observe for signs of bleeding (bruising or bleeding from site, blood in urine/stools)
Patient teaching for vitamin k
Report symptoms of bleeding or bruising, blood in urine, or black tarry stools
Periodic lab tests to monitor coagulation
Dose for erythromycin eye ointment
1 cm ribbon into each conjunctival sac
Use for erythromycin eye ointment
*Prophylaxis for gonorrhea in eyes
Action of erythromycin eye ointment
Inhibits protein synthesis in bacteria (bacteriostatic)
Side effects of erythromycin eye ointment
Temporary blurred vision
Chemical conjunctivitis
Burning
Itching
Redness
Nursing responsibilities for erythromycin eye ointment
*Apply - inner to outer canthus, may wipe away after 1 minute
*Give within 1-2 hours after birth
Observe for irritation
Patient teaching for erythromycin eye ointment
Med does not need to be rinsed from infant’s eyes
Infant’s vision will be blurred while medication is in place
Not treating the infant could lead to blindness from infection
