Sim: Postpartum Hemorrhage Drugs Flashcards
1
Q
what is the trade name for oxytocin?
A
Pitocin
2
Q
oxytocin: indications
A
- induction or augmentation of labor
- control of postpartum bleeding
- inevitable or incomplete abortion
3
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
4
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
5
Q
oxytocin: dosage for inevitable or incomplete abortion
A
- 10 units at a rate of 10-20 milliunits/min
6
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
7
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
- record BP, pulse, and RR every 30-60 min or with each dose inc
8
Q
oxytocin: nursing implications postpartum
A
- 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
9
Q
what is the trade name for misoprostol?
A
Cytotec
10
Q
Misoprostol: indications
A
- cervical ripening
- induction of labor
- termination of pregnancy
11
Q
Misoprostol: dosage
A
- 25 mcg vaginally
- must be prepared by pharmacist–broken from a 100 or 200 mcg tablet
- 100 mcg orally
12
Q
Misoprostol: ADRs
A
- uterine hyperstimulation
- contraindicated in a womean with previous cesarean or other uterine surgery
13
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)
14
Q
what is the trade name for Carboprost tromethamine?
A
Hemabate
15
Q
Carboprost tromethamine: Indications
A
- Used for tx of postpartum hemorrhage caused by uterine atony
- Abortion
