Week 3

Question 1

oxytocin: trade name

Answer 1

Pitocin

Question 2

oxytocin: indications

Answer 2

• 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)

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
• given by pump
• titrated according to contraction pattern
• record BP, pulse, and RR every 30-60 min or with each dose inc

Question 8

oxytocin: nursing implications postpartum

Answer 8

• 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

Question 9

Misoprostol: trade name

Answer 9

Cytotec

Question 10

Misoprostol: indications

Answer 10

• cervical ripening
  
  • make the cervix more favorable so you can administer oxytocin
• 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

Dinoprostone: classification

Answer 14

Cervidil

Question 15

Dinoprostone: indications

Answer 15

• cervical ripening
  
  • make the cervix more favorable so you can administer oxytocin

Question 16

Dinoprostone: dosage

Answer 16

• 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

Question 17

Dinoprostone: ADRs

Answer 17

• hypertonic contractions (uterine hypertonicity)
• amniotic fluid embolism
• uterine rupture

Question 18

Dinoprostone: nursing implications

Answer 18

• 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

Question 19

Butorphanol tartrate: trade name

Answer 19

Stadol

Question 20

butorphanol tartrate: indications

Answer 20

• systemic pain relief during labor

Question 21

butorphanol tartrate: dosage

Answer 21

• IV: 1 mg every 3-4 hour
  
  • range 0.5-2 mg

Question 22

butorphanol tartrate: ADRs

Answer 22

• 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

Question 23

butorphanol tartrate: nursing implications

Answer 23

• 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

Question 24

hydralazine: trade name

Answer 24

Apresoline

Question 25

hydralazine: indications

Answer 25

• vasodilator to help with pregnancy induced HTN (PIH)
  
  • used for inpatient management of severe preeclampsia

Question 26

hydralazine: dosage

Answer 26

• 5 mg q 15–20 min
  
  • if no response after a total of 20 mg, consider an alternative agent.

Question 27

hydralazine: ADRs

Answer 27

• tachycardia
• sodium/fluid retention
• drug induced lupus
• n/v/d
• edema
• HA
• dizziness

Question 28

hydralazine: nursing implications

Answer 28

• monitor BP and pulse frequently
• administer with meals
• educate client to continue to take meds even if feeling better
• monitor weight to assess for edema

Question 29

magnesium sulfate: indications

Answer 29

• prevention and control of seizures in severe preeclampsia
• prevention of uterine contractions in preterm labor

Question 30

magnesium sulfate: dosage

Answer 30

• IV: loading dose then continuous infusion
  
  • loading dose is 4-6 g administered in 100 mL of IV fluid over 15-20 min
  • continuing infusion to maintain control is 2g/hr
• may be given IM but will be very painful

Question 31

magnesium sulfate: ADRs

Answer 31

• from magnesium overdose:
  
  • flushing
  • sweating
  • hypoTN
  • depressed DTRs
  • CNS depression (including respiratory depression)

Question 32

magnesium sulfate: nursing implications

Answer 32

• monitor BP closely during administration
• assess woman for respiratory rate above 12 breaths/minute, presence of DTRs, and urinary output greater than 30 mL/hour before administering
• place resuscitation equipment in room
• keep calcium gluconate (antidote) in room with syringes and needles