Sim: Postpartum Hemorrhage Drugs

Question 1

what is the trade name for oxytocin?

Answer 1

Pitocin

Question 2

oxytocin: indications

Answer 2

• induction or augmentation of labor
• control of postpartum bleeding
• inevitable or incomplete abortion

Question 3

oxytocin: dosage for induction or augmentation of labor

Answer 3

• 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

Question 4

oxytocin: dosage for control of postpartum bleeding

Answer 4

• 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

Question 5

oxytocin: dosage for inevitable or incomplete abortion

Answer 5

• 10 units at a rate of 10-20 milliunits/min

Question 6

oxytocin: ADRs

Answer 6

• 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

Question 7

oxytocin: nursing implications intrapartum

Answer 7

• 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
• record BP, pulse, and RR every 30-60 min or with each dose inc

Question 8

oxytocin: nursing implications postpartum

Answer 8

• 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

Question 9

what is the trade name for misoprostol?

Answer 9

Cytotec

Question 10

Misoprostol: indications

Answer 10

• cervical ripening
• induction of labor
• termination of pregnancy

Question 11

Misoprostol: dosage

Answer 11

• 25 mcg vaginally
  
  • must be prepared by pharmacist–broken from a 100 or 200 mcg tablet
• 100 mcg orally

Question 12

Misoprostol: ADRs

Answer 12

• uterine hyperstimulation
• contraindicated in a womean with previous cesarean or other uterine surgery

Question 13

Misoprostol: nursing implications

Answer 13

• 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)

Question 14

what is the trade name for Carboprost tromethamine?

Answer 14

Hemabate

Question 15

Carboprost tromethamine: Indications

Answer 15

• Used for tx of postpartum hemorrhage caused by uterine atony
• Abortion

Question 16

Carboprost tromethamine: dosage

Answer 16

• Postpartum hemorrhage: 250 mcg IM
  
  • May repeat at 15-90 min intervals
  • Max dose: 2 mg

Question 17

Carboprost Tromethamine: ADRs

Answer 17

• Tetanic contraction and laceration
• Uterine rupture
• Uterine hypertonus if used w/ oxytocin
• n/v/d
• Fever
• Flushing
• HA
• HTN or hypoTN
• Tachycardia
• Pulmonary edema

Question 18

Carboprost tromethamine: Nursing implications

Answer 18

• Refrigerate drug
• Give via deep IM injection and aspirate carefully to avoid IV injection
• Rotate sites if repeated
• Monitor V/S
• Administer antiemetics and antidiarrheals as ordered

Question 19

Methylergonovine: trade name

Answer 19

Methergine

Question 20

Methylergonovine: indications

Answer 20

• Used for prevention and tx of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution

Question 21

Methylergonovine: dosage

Answer 21

• 0.2 mg IM every 2-4 hours for max 5 doses
• Change to oral route 0.2 mg every 6-8 hours for max 7 days
• IV usage not recommended
  
  • Only in life threatening emergency
  • Give over 60 sec w/ close monitoring of BP and pulse

Question 22

Methylergonovine: ADRs

Answer 22

• n/v
• Uterine cramping
• HTN
• Dizziness
• HA
• Dyspnea
• Chest pain
• Palpitations
• Peripheral ischemia
• Seizure
• Uterine and GI cramping

Question 23

Methylergonovine: Nursing implications

Answer 23

• Before admin, assess BP
  
  • Withhold if hospital policy says you should at a certain level
• Tell mother to avoid smoking b/c constricts vessels and will inc BP
• Report any ADRs