Question

10. When TA returns to bed and the external fetal monitor is reapplied, what data should the nurse collect, record, and report to the obstetric provider? It is 24 hours since TA had the first gel instillation and 6 hours since her last insertion. A vaginal examination reveals that TA’s cervix is soft, 50% effaced, and 3 cm dilated and that the presenting part is at 2 station. Contractions are 5 minutes apart and mild, and the health care provider elects to begin an oxytocin infusion.

11. TA asks how “a medicine running into my arm is able to make my uterus contract.” How should the nurse explain the mode of action of oxytocin to TA?

12. Why is the oxytocin infusion run through a secondary line attached as a piggyback to the primary line? At which port along the primary line is the piggyback inserted and why?

13. Why is oxytocin administered via infusion pump? What is the measurement for dosing?

14. In regard to the IV equipment setup, what actions should be taken as safety measures before starting the oxytocin?

15. What drugs should be nearby in the event of an emergency with the oxytocin?

16. What information should be recorded during the infusion?

Answer 1

10. The nurse should collect, record, and report to the obstetric provider the fetal movements, fetal distress, partial placenta previa, borderline cephalopelvic disproportion, hydramnios, fetal heart rate, cervical effacement, dilation of cervix, nature and duration of contractions, position of fetus/presenting part etc., of TA. Other than this, TA’s vital signs including blood pressure, pulse, respirations, temperature etc., should also be recorded and needs to be reported.

11. Oxytocin acts as a stimulant for the uterine muscles and helps it to contract, which is done with the help of oxytocin receptors in the myometrium. The production of prostaglandins is also increased by the oxytocin, which further increases the contractions. It is given on hand and it acts on uterine muscles as there is a proper path of drug absorption and action.

12. The oxytocin infusion is run through a secondary line attached as a piggyback to the primary line as it can be stopped abruptly without interrupting the infusion of electrolyte. The rate of infusion needs to be controlled accurately and is done using an infusion pump and by giving oxytocin as a piggyback on a primary line of physiologic electrolyte.The piggyback with the infusion pump should be attached to the infusion line, at a port closer to the infusion site.

13. Oxytocin is administered via infusion pump as the rate of infusion needs to be controlled accurately to stop it abruptly, or to increase or decrease the speed of administration. The dosing is measured as mU/min, which is 0.5 to 1 mU/min initially at 30 minute intervals the dose should be increased in increments 1-2 mU/min gradually until the required pattern of contraction is established. Once the required pattern is reached and the uterus becomes 5-6 cm dilated, the dose is decreased in a similar manner.