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NSG432 OB/GYNEO Exam 1 Drugs High yield
Nursing Care of the Childbearing Family (NSG-432)
Grand Canyon University
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Exam 1 Friday, January 14, 2022 7:59 AM Topic 1 Topic 2: Laboring woman family during labor and birth, obstetrical pain management fetal assessment 1. Drugs used for induction methods: Pitocin (oxytocin) Prostaglandin E2: Dinoprostone Given IV per IV pump, slowly. 1. Obstetrical pain management A. Sedatives: not for pain relief, they are for relieving anxiety and inducing good for women who are having a prolonged latent phase (dilation from We use this when we are close to delivery Sometimes we use opioids (not as often) Barbiturates: should be avoided if birth is anticipated within hours potential neonatal CNS depression Phenothiazines Benzodiazepines: when given with opioids enhance pain relief, reduce Maternal amnesia avoid during labor Diazepam: disrupts thermoregulation in newborns, making them less able to maintain body temperature Flumazenil: antidote B. Analgesia: systemic analgesia 1. Opioid agonist Indication: Moderate to severe labor pain and postoperative pain after i. Meperidine (Demerol) Onset of action: immediately after administration lasts for hrs Dosage route: IV 25 to 50 mg every 1 to 2 hours PCA Pump: 15 mg every 10 minutes as needed until birth tachycardia, sedation, altered mental status, euphoria, decreased gastric motility, delayed gastric emptying, and urinary retention Nursing considerations: Cannot be reversed with Side rails assistance with ambulation Do not give if birth is expected to occur within hours after administration infants born to women who received meperidine can have respiratory peaking at hours after administration of the drug We use this medication often because it crosses the placenta and cause prolonged neonatal sedation and neurobehavioral changes Long half life SO effects can last first days of life Effective for relieving severe persistent or recurrent pain ii. Fentanyl (Sublimaze) Onset of action: rapidly crosses the placenta SO is present in fetal blood within 1 minute after intravenous maternal administration (0 to 1 hour 1 to 2 hours IM) sedation, respiratory depression, nausea, and vomiting Less neonatal effects less maternal sedation and nausea Rapid onset of action, short and lack of a metabolite A disadvantage of fentanyl is that more frequent dosing is required because of its relatively short duration of action Nursing considerations: Maximum total dose for labor is usually 500 to 600 mcg Assess for respiratory depression Naloxone as antidote Side rails assistance Exam 1 Friday, January 14, 2022 7:59 AM Topic 1 Topic 2: Laboring woman family during labor and birth, obstetrical pain management fetal assessment 1. Drugs used for induction methods: Pitocin (oxytocin) Prostaglandin E2: Dinoprostone Given IV per IV pump, slowly. 1. Obstetrical pain management A. Sedatives: not for pain relief, they are for relieving anxiety and inducing good for women who are having a prolonged latent phase (dilation from We use this when we are close to delivery Sometimes we use opioids (not as often) Barbiturates: should be avoided if birth is anticipated within hours potential neonatal CNS depression Phenothiazines Benzodiazepines: when given with opioids enhance pain relief, reduce Maternal amnesia avoid during labor Diazepam: disrupts thermoregulation in newborns, making them less able to maintain body temperature Flumazenil: antidote B. Analgesia: systemic analgesia 1. Opioid agonist Indication: Moderate to severe labor pain and postoperative pain after i. Meperidine (Demerol) Onset of action: immediately after administration lasts for hrs Dosage route: IV 25 to 50 mg every 1 to 2 hours PCA Pump: 15 mg every 10 minutes as needed until birth tachycardia, sedation, altered mental status, euphoria, decreased gastric motility, delayed gastric emptying, and urinary retention Nursing considerations: Cannot be reversed with Side rails assistance with ambulation Do not give if birth is expected to occur within hours after administration infants born to women who received meperidine can have respiratory peaking at hours after administration of the drug We use this medication often because it crosses the placenta and cause prolonged neonatal sedation and neurobehavioral changes Long half life SO effects can last first days of life Effective for relieving severe persistent or recurrent pain ii. Fentanyl (Sublimaze) Onset of action: rapidly crosses the placenta SO is present in fetal blood within 1 minute after intravenous maternal administration (0 to 1 hour 1 to 2 hours IM) sedation, respiratory depression, nausea, and vomiting Less neonatal effects less maternal sedation and nausea Rapid onset of action, short and lack of a metabolite A disadvantage of fentanyl is that more frequent dosing is required because of its relatively short duration of action Nursing considerations: Maximum total dose for labor is usually 500 to 600 mcg Assess for respiratory depression Naloxone as antidote Side rails assistance Pain relief measures Most commonly administered PCA pump or frequently dosing IV Intrathecally or epidurally Remifentanil Hydrochloride (Ultiva) Onset of action: has a rapid onset of action (approximately 1 minute). Because of its very short (only 3 minutes), Remifentanil should be administered only PCA pump Indication: moderate to severe labor pain Sedation and hypoventilation with oxygen desaturations Nursing considerations: Close maternal monitoring (suggested 1 ratio) and continuous oxygen saturation monitoring are required IV line Nonpharm pain relief measures Can be given to patients with impaired renal or hepatic 2. Opioid Nalbuphine Hydrochloride (Nubain) Indication: sedation, drowsiness, dizziness, respiratory depression, temporary absent or minimal FHR variability Nursing considerations: May precipitate withdrawal symptoms in women and their newborns Assess maternal vital signs, degree of pain, FHR, and uterine activity before and after administration Observe maternal VS, degree of pain, FHR, uterine activity before and after admin Notifying HCP if maternal respirations are breaths per minute Encourage voiding every 2 hours, and palpate for bladder distention If birth occurs within 1 to 4 hours of dose administration, observe newborn for respiratory depression Use of side rails and assistance with ambulation Nonpharm pain relief measures An opioid antagonist (e., naloxone is contraindicated for women because it may precipitate abstinence syndrome (withdrawal symptoms). For the same reason, opioid analgesics such as nalbuphine (Nubain) should not be given to dependent women Butorphanol (Stadol) Can cause CNS depression in mom and ba (or both) Low doses of IV have reduced the severity Infants may exhibit respiratory depression, hypotonia, lethargy and delay in temperature regulation Risk for hypoxia, hyperacidosis increases if the neonate not treated promptly Narcan can reverse and does not replace ventilation SO we need O2 and gentle stimulation A lot of these babies go to NICU we need one on one observation for first 24 hrs Naloxone (Narcan) Nursing Considerations The woman should delay breastfeeding until medication is out of her system (approximately 2 hours after the last dose is given) Do not give to the woman or the newborn if the woman is opioid cause abrupt withdrawal in the woman and newborn If given to the woman for reversal of respiratory depression caused opioid analgesie, pain will return suddenly The duration of action of naloxone is shorter than that of most opioids. Pain relief measures Most commonly administered PCA pump or frequently dosing IV Intrathecally or epidurally Remifentanil Hydrochloride (Ultiva) Onset of action: has a rapid onset of action (approximately 1 minute). Because of its very short (only 3 minutes), Remifentanil should be administered only PCA pump Indication: moderate to severe labor pain Sedation and hypoventilation with oxygen desaturations Nursing considerations: Close maternal monitoring (suggested 1 ratio) and continuous oxygen saturation monitoring are required IV line Nonpharm pain relief measures Can be given to patients with impaired renal or hepatic 2. Opioid Nalbuphine Hydrochloride (Nubain) Indication: sedation, drowsiness, dizziness, respiratory depression, temporary absent or minimal FHR variability Nursing considerations: May precipitate withdrawal symptoms in women and their newborns Assess maternal vital signs, degree of pain, FHR, and uterine activity before and after administration Observe maternal VS, degree of pain, FHR, uterine activity before and after admin Notifying HCP if maternal respirations are breaths per minute Encourage voiding every 2 hours, and palpate for bladder distention If birth occurs within 1 to 4 hours of dose administration, observe newborn for respiratory depression Use of side rails and assistance with ambulation Nonpharm pain relief measures An opioid antagonist (e., naloxone is contraindicated for women because it may precipitate abstinence syndrome (withdrawal symptoms). For the same reason, opioid analgesics such as nalbuphine (Nubain) should not be given to dependent women Butorphanol (Stadol) Can cause CNS depression in mom and ba (or both) Low doses of IV have reduced the severity Infants may exhibit respiratory depression, hypotonia, lethargy and delay in temperature regulation Risk for hypoxia, hyperacidosis increases if the neonate not treated promptly Narcan can reverse and does not replace ventilation SO we need O2 and gentle stimulation A lot of these babies go to NICU we need one on one observation for first 24 hrs Naloxone (Narcan) Nursing Considerations The woman should delay breastfeeding until medication is out of her system (approximately 2 hours after the last dose is given) Do not give to the woman or the newborn if the woman is opioid cause abrupt withdrawal in the woman and newborn If given to the woman for reversal of respiratory depression caused opioid analgesie, pain will return suddenly The duration of action of naloxone is shorter than that of most opioids. Remove catheter if educated to do SO Initiate emergency protocols Assess for return of sensory and motor function in addition to the usual postpartum assessments Nurse continues to monitor maternal vital signs and FHR and pattern at frequent intervals, the strength and frequency of uterine contractions, changes in the cervix and station of the presenting part, the presence and quality of the reflex, bladder filling, and state of hydration After receiving a neuraxial block or opioid intravenously for pain, the woman should not be allowed to ambulate alone. She must either remain in bed or request assistance before attempting to get out of bed. The nurse assesses the woman for signs of orthostatic hypotension and return of sensation and motor function of the lower extremities prior to ambulation D. Nerve blocks Pudendal: administered late in the second stage of labor third stage if an episiotomy or lacerations must be repaired is useful if an episiotomy is to be performed or if forceps or a vacuum extractor are to be used to facilitate birth pudendal nerve block does not relieve the pain from uterine contractions, it does relieve pain in the lower vagina, the vulva, and the perineum should be administered 10 to 20 minutes before perineal anesthesia is needed Pudendal block does not change maternal hemodynamic or respiratory functions, vital signs, or the FHR reflex is lessened or lost completely To reduce the risk for transmission of pathogens, the back is cleansed before the procedure. Before the induction of spinal and epidural anesthesia or analgesia, the anesthesia care provider removes jewelry and washes during the procedure he or she wears sterile gloves and a fresh face mask Epidural anesthesia: Correct space located: 4th and 5th lumbar vertebrae For relieving the discomfort of labor and vaginal birth, a block from T10 to S5 is required For cesarean birth, a block from at least T8 to S1 is essential Side effects: Bladder distention, elevated temperature, short or long term backache, disruption of labor, increased length of first and second of labor, increased use of oxytocin, increased use of instrumentation, increased incidence of cesarean section Nursing considerations: Baseline maternal vital signs and FHR Have patient void Hydrate with mL LR or NS O2 ready Position patient either side lying or sitting up on edge of bed Vital signs after procedure per protocol Complications: Hypotension leading to fetal bradycardia or late decelerations Intravascular injection Total spinal Spinal headache Infection Impotent block or block Epidural hematoma Spinal or epidural anesthesia or analgesia should not be initiated if the woman has a tattoo at the site where the needle would be inserted Nursing considerations: After administration, she should be positioned to her side SO uterus compress ascending vena cava descending aorta impair venous return, reduce CO BP, decrease placental perfusion Position should be alternated side to side every hour Remove catheter if educated to do SO Initiate emergency protocols Assess for return of sensory and motor function in addition to the usual postpartum assessments Nurse continues to monitor maternal vital signs and FHR and pattern at frequent intervals, the strength and frequency of uterine contractions, changes in the cervix and station of the presenting part, the presence and quality of the reflex, bladder filling, and state of hydration After receiving a neuraxial block or opioid intravenously for pain, the woman should not be allowed to ambulate alone. She must either remain in bed or request assistance before attempting to get out of bed. The nurse assesses the woman for signs of orthostatic hypotension and return of sensation and motor function of the lower extremities prior to ambulation D. Nerve blocks Pudendal: administered late in the second stage of labor third stage if an episiotomy or lacerations must be repaired is useful if an episiotomy is to be performed or if forceps or a vacuum extractor are to be used to facilitate birth pudendal nerve block does not relieve the pain from uterine contractions, it does relieve pain in the lower vagina, the vulva, and the perineum should be administered 10 to 20 minutes before perineal anesthesia is needed Pudendal block does not change maternal hemodynamic or respiratory functions, vital signs, or the FHR reflex is lessened or lost completely To reduce the risk for transmission of pathogens, the back is cleansed before the procedure. Before the induction of spinal and epidural anesthesia or analgesia, the anesthesia care provider removes jewelry and washes during the procedure he or she wears sterile gloves and a fresh face mask Epidural anesthesia: Correct space located: 4th and 5th lumbar vertebrae For relieving the discomfort of labor and vaginal birth, a block from T10 to S5 is required For cesarean birth, a block from at least T8 to S1 is essential Side effects: Bladder distention, elevated temperature, short or long term backache, disruption of labor, increased length of first and second of labor, increased use of oxytocin, increased use of instrumentation, increased incidence of cesarean section Nursing considerations: Baseline maternal vital signs and FHR Have patient void Hydrate with mL LR or NS O2 ready Position patient either side lying or sitting up on edge of bed Vital signs after procedure per protocol Complications: Hypotension leading to fetal bradycardia or late decelerations Intravascular injection Total spinal Spinal headache Infection Impotent block or block Epidural hematoma Spinal or epidural anesthesia or analgesia should not be initiated if the woman has a tattoo at the site where the needle would be inserted Nursing considerations: After administration, she should be positioned to her side SO uterus compress ascending vena cava descending aorta impair venous return, reduce CO BP, decrease placental perfusion Position should be alternated side to side every hour Oxygen should be available if hypotension occurs despite maintenance of hydration with IV fluid and displacement of the uterus to the side Ephedrine or phenylephrine (vasopressors used to increase maternal blood pressure) and increased IV fluid infusion may be needed The FHR and pattern, contraction pattern, and progress in labor must be monitored carefully because the woman may not be aware of changes in the strength of the uterine contractions or the descent of the presenting part Epidural anesthesia effectively relieves the pain caused uterine contractions. For most women, however, it does not completely remove the pressure sensations that occur as the fetus descends in the pelvis. Spinal anesthesia (25 gauge, local anesthesia or combined with opioid analgesic) Correct space located: 3rd, 4th, 5th lumbar interspace to the subarachnoid space Onset: immediate Volume: small amount generally 2 mL Medication: Marcaine with dextrose (isobaric) Marked hypotension, impaired placental perfusion, and an ineffective breathing pattern may occur during spinal anesthesia Spinal headache: if leakage of CSF from site of puncture of dura mater Upright position increases pain, supine relieves headache, tinnitus, photophobia, blurred vision (being within 2 days of puncture and persists for days or weeks) Tx: oral analgesics methylxanthines (caffeine) Epidural blood patch: rapid, most reliable and beneficial relief measure 20 mL of her blood is injected slowly into her lumbar epidural space and creating a clot that patches the tear or hole in dura only when other tx options are unsuccessful and resolve Nursing considerations: Assess for VS, pallor, clammy skin, leakage of CSF for 1 hr then resume normal activity Educate to avoid coughing or straining for first day Positioning Spinal or epidural anesthesia or analgesia should not be initiated if the woman has a tattoo at the site where the needle would be inserted Low spinal anesthesia (block) may be used for vaginal birth, but it is not suitable for labor Nursing considerations: Before induction of the spinal anesthetic, maternal vital signs are assessed and a to electronic fetal monitoring (EFM) strip is obtained and evaluated. In addition, the fluid balance is assessed A bolus of IV fluid (usually 500 to mL of lactated or normal saline solution) may be administered 15 to 30 minutes before induction of the anesthetic to decrease the potential for hypotension caused sympathetic blockade (vasodilation with pooling of blood in the lower extremities decreases cardiac output) After administration of the anesthetic, maternal blood pressure, pulse, and respirations and FHR and pattern must be assessed and documented every 5 to 10 minutes If signs of serious maternal hypotension (e., a drop in systolic blood pressure to 100 mm Hg or less or below of the baseline blood pressure) or fetal distress (e., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given: Maternal Hypotension With Decreased Placental Perfusion Signs and Symptoms: maternal hypotension decrease from preblock baseline level or mm Hg systolic), fetal bradycardia absent or minimal FHR variability Interventions: One. Turn woman to lateral position, or place pillow or wedge under hip to displace uterus Two. Maintain intravenous (IV) infusion at rate specified, or increase administration per hospital protocol Three. Administer oxygen nonrebreather face mask at 10 to 12 or per protocol Four. Elevate the legs Five. Notify the primary health care provider, anesthesiologist, or nurse anesthetist Oxygen should be available if hypotension occurs despite maintenance of hydration with IV fluid and displacement of the uterus to the side Ephedrine or phenylephrine (vasopressors used to increase maternal blood pressure) and increased IV fluid infusion may be needed The FHR and pattern, contraction pattern, and progress in labor must be monitored carefully because the woman may not be aware of changes in the strength of the uterine contractions or the descent of the presenting part Epidural anesthesia effectively relieves the pain caused uterine contractions. For most women, however, it does not completely remove the pressure sensations that occur as the fetus descends in the pelvis. Spinal anesthesia (25 gauge, local anesthesia or combined with opioid analgesic) Correct space located: 3rd, 4th, 5th lumbar interspace to the subarachnoid space Onset: immediate Volume: small amount generally 2 mL Medication: Marcaine with dextrose (isobaric) Marked hypotension, impaired placental perfusion, and an ineffective breathing pattern may occur during spinal anesthesia Spinal headache: if leakage of CSF from site of puncture of dura mater Upright position increases pain, supine relieves headache, tinnitus, photophobia, blurred vision (being within 2 days of puncture and persists for days or weeks) Tx: oral analgesics methylxanthines (caffeine) Epidural blood patch: rapid, most reliable and beneficial relief measure 20 mL of her blood is injected slowly into her lumbar epidural space and creating a clot that patches the tear or hole in dura only when other tx options are unsuccessful and resolve Nursing considerations: Assess for VS, pallor, clammy skin, leakage of CSF for 1 hr then resume normal activity Educate to avoid coughing or straining for first day Positioning Spinal or epidural anesthesia or analgesia should not be initiated if the woman has a tattoo at the site where the needle would be inserted Low spinal anesthesia (block) may be used for vaginal birth, but it is not suitable for labor Nursing considerations: Before induction of the spinal anesthetic, maternal vital signs are assessed and a to electronic fetal monitoring (EFM) strip is obtained and evaluated. In addition, the fluid balance is assessed A bolus of IV fluid (usually 500 to mL of lactated or normal saline solution) may be administered 15 to 30 minutes before induction of the anesthetic to decrease the potential for hypotension caused sympathetic blockade (vasodilation with pooling of blood in the lower extremities decreases cardiac output) After administration of the anesthetic, maternal blood pressure, pulse, and respirations and FHR and pattern must be assessed and documented every 5 to 10 minutes If signs of serious maternal hypotension (e., a drop in systolic blood pressure to 100 mm Hg or less or below of the baseline blood pressure) or fetal distress (e., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given: Maternal Hypotension With Decreased Placental Perfusion Signs and Symptoms: maternal hypotension decrease from preblock baseline level or mm Hg systolic), fetal bradycardia absent or minimal FHR variability Interventions: One. Turn woman to lateral position, or place pillow or wedge under hip to displace uterus Two. Maintain intravenous (IV) infusion at rate specified, or increase administration per hospital protocol Three. Administer oxygen nonrebreather face mask at 10 to 12 or per protocol Four. Elevate the legs Five. Notify the primary health care provider, anesthesiologist, or nurse anesthetist
NSG432 OB/GYNEO Exam 1 Drugs High yield
Course: Nursing Care of the Childbearing Family (NSG-432)
University: Grand Canyon University
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