Week 4

Question 1

Fentanyl: trade name

Answer 1

Duragesic

Question 2

Fentanyl: indications

Answer 2

• intrapartum pain management
  
  • opioid analgesics
  • used as an adjunct to epidural analgesia

Question 3

Fentanyl: dosage

Answer 3

• 50-100 mcg
  
  • may be repeated every hour
  • may be given by PCA

Question 4

Fentanyl: ADRs

Answer 4

• pruritis
• n/v
• delayed respiratory depression: for up to 12 hr after administration

Question 5

Fentanyl: nursing implications

Answer 5

• record baseline maternal V/S and FHR
• nurse should observe for signs of subarachnoid puncture or intravascular injection
• assess maternal BP and FHR every 5 min furing first 15 min after administration
  
  • repeat at 30 min and at 1 hour after procedure
• assess bladder every 2 hour
  
  • may need to obtain order for catheter placement
• observe neonate for respiratory depression (esp if drug given w/in 4 hours of birth)
• can use adjunctive therapy for nausea (promethazine)
• have naloxone and respiratory resuscitation equipment ready

Question 6

Bupivicaine: trade name

Answer 6

Marcaine

Question 7

Bupivicaine: indications

Answer 7

• epidural block
  
  • for intrapartum pain management
• local anesthetic: for episiotomy, to repair tear or laceration

Question 8

Bupivicaine: dosage

Answer 8

• 10-20 mL
  
  • administer in increments of 3-5 mL
  • do a test dose of 3 mL before full administration

Question 9

Bupivicaine: ADRs

Answer 9

• maternal hypoTN
• bladder distention
• prolonged 2nd stage of labor
• epidural catheter migration
• cesarean births
• maternal fever
• can cause seizure if injected into vessel

Question 10

Bupivicaine: nursing implications

Answer 10

• often times administered with epi to prevent bleeding
• record baseline maternal V/S and FHR
• nurse should observe for signs of subarachnoid puncture or intravascular injection
• assess maternal BP and FHR every 5 min furing first 15 min after administration
  
  • repeat at 30 min and at 1 hour after procedure
• assess bladder every 2 hour and encourage mom to void
  
  • may need to obtain order for catheter placement
• prehydrate woman with LR or NS
• displace uterus with wedge under woman’s side to enhance placental perfusion
  
  • assess FHR for signs of impaired placental perfusion
  • if impaired placental perfusion or hypoTN occur: administer nonadditive IV fluid, reposition woman on side, administer 8-10 L/min of O2

Question 11

what is the trade name for terbutaline sulfate?

Answer 11

Brethine

Question 12

Terbutaline sulfate: indications

Answer 12

• tocolytic: management of preterm labor–>inhibition of uterine contractions

Question 13

Terbutaline sulfate: dosage

Answer 13

• IV: 0.01-0.05 mg/min
  
  • inc rate by 0.01 mg/min at 10-30 min intervals until contractions or maximum dose of 0.08 mg/min is reached
  • maintain dose for 1 hour, then reduce rate at 30 min intervals to reach minimum maintenance dose when contractions stop
  • continue maintenance dose for 12 horus
• subQ: intermittent injections of 0.25 mg every 4 hour

Question 14

Terbutaline sulfate: ADRs

Answer 14

• CV: maternal and fetal tachycardia, palpitations, cardiac dysrhythmias, chest pain, wide pulse pressure
• resp: dyspnea, chest discomfort
• CNS: tremors, restlessness, weakness, HA, dizziness
• metabolic: hypokalemia, hyperglycemia
• GI: n/v, reduced bowel motility
• skin: flushing, diaphoresis

Question 15

Terbutaline sulfate: nursing implications

Answer 15

• do not use for longer than 48-72 hour
• assess woman’s apical HR and lung sounds before administering each dose
  
  • drug toxicity and d/c drug if: maternal HR over 120 bpm or respiratory findings such as “wet” lung sounds or more rapid rate
• report all non-reassuring maternal and fetal assessments to physician
• have propranolol ready as a reversal agent

Question 16

what is the trade name for nifedipine?

Answer 16

Procardia

Question 17

Nifedipine: indications

Answer 17

• CCB used for tocolysis
  
  • reduce uterine contractions b/c Ca is essential for muscular contractions (for preterm labor)

Question 18

Nifedipine: dosage

Answer 18

• oral loading dose: 10-20 mg
• continued oral therapy: 10-20 mg every 3-6 hr until contractions are rare
  
  • followed by long acting formulations of 30-60 mg every 8-12 hr until antepartum steroids have been administered

Question 19

Nifedipine: ADRs

Answer 19

• flushing
• HA
• inc in maternal and fetal HR
• maternal postural hypotension
• hyperglycemia

Question 20

Nifedipine: nursing implications

Answer 20

• observe for SEs
• report maternal pulse greater than 120 bpm
• educate on possible dizziness or faintness
  
  • sit or stand slowly and call for assistance if needed

Question 21

what is the trade name for betamethasone?

Answer 21

Celestone

Question 22

Betamethasone: indications

Answer 22

• acceleration of fetal lung maturity to reduce the incidence and severity of respiratory distress syndrome (RDS)
  
  • greatest benefits if at least 24 hrs elapse b/w initial dose and birth of preterm infant
  • indicated if gestation b/w 24-34 wks

Question 23

Betamethasone: dosage

Answer 23

• 12 mg IM for 2 doses, 24 hours apart

Question 24

Betamethasone: ADRs

Answer 24

• few b/c short term use of drug
• pulmonary edema possible secondary to sodium and fluid retention
• fever and elevated pulse rate secondary to infection
• UTI
• hyperglycemia

Question 25

Betamethasone: nursing considerations

Answer 25

* educate woman on potential benefits, but tell her drug cannot prevent all complications of prematurity * if woman has diabetes, more frequent blood glucose checks are needed * WBCs greater than 20,000 may indicate infection * assess lung sounds * report chest pain, heaviness, or dyspnea * report pain or burning with urination * assess V/S for fever and elevated pulse

Question 26

what is the trade name for Indomethacin?

Answer 26

Indocin

Question 27

Indomethacin: indications

Answer 27

* tocolytic: to inhibit uterine contractions (for preterm labor) * can be used to normalize volume of amniotic fluid if hydramnios is present

Question 28

Indomethacin: dosage

Answer 28

* loading dose: 50 mg orally

Question 29

Indomethacin: ADRs

Answer 29

* Maternal: * GI: n/v/heartburn * asthm ain aspirin sensitive women * inc BP in hypertensive women * Fetal: * constriction of ductus arteriosus * pulmonary HTN * oligohydramnios (usually returns to normal when drug is d/c)

Question 30

Indomethacin: nursing implications

Answer 30

* limit use to preterm labor before 32 weeks gestation * use for no longer than 48-72 consecutive hours * observe for GI SEs * observe for abnormal bleeding (such as prolonged bleeding after injection and bruising with no apparent cause) * watch for signs of infection, b/c drug may mask them * check height of fundus at beginning of therapy and daily thereafter to identify reduced amniotic fluid * observe for decreased fetal movements and absent FHR accelerations w/ fetal movement (may indicate fetal condition deteriorating) * use U/S and fetal echocardiography to determine if drug having adverse effects on fetus