Question

40. List 3 medications that ae uwed for uerne adony, For eadh metiaio a) Drug class b) Mechanism of action c) Major side effects d) Nursing considerations and interventions e) Patient teaching lo receive flu vaccin

Answer 1

Ans) Uterotonic drugs including oxytocin, methylergonovine (Methergine), and prostaglandins, such as Hemabate.

1) Oxytocin:

a) Drug class: Hormonal agent- Uterine Smooth Muscle stimulant.

b) Mechanism of action:

1. Naturally occurring posterior pituitary hormone
a. Stimulates contraction of the uterine smooth muscle
b. Stimulates mammary gland smooth muscle resulting in lactation
c. Increases renal, coronary and cerebral blood flow.

c) Major side effects:

Maternal Side Effects:

Cardiovascular: dysrhythmias, chest pain, hypertension
Neurological: seizures
Respiratory: dyspnea
Gastrointestinal: nausea/vomiting
Genitourinary: Severe uterine cramping, uterine rupture
Fetal Side Effects: Cardiovascular: bradycardia, ectopic rhythms
Neurological: intracranial hemorrhage
Respiratory: hypoxia, asphyxia

d) Nursing consideration and intervention:

1. Frequent assess baseline vital signs, blood pressure, and fetal heart rate.

2. Constantly monitor frequency, duration, and strength of contractions.

3. Stop the infusion: notify the physician if the resting uterine pressure is greater than 15 to 20 mm Hg, If contractions are lasting longer than 1 minute or if they are occurring more frequently than every 2 to 3 minutes, or if an alteration in fetal heart rhythm or rate occurs.

4. Maintain input and output; evaluate for excessive water retention.

5. Do not confuse with vasopressin/Pitressin, which is an antidiuretic hormone.

Precaution:

- Ensure that the baby (babies) and the placenta have been delivered prior to administration to prevent placental retention.

Health teaching:

Before you receive oxytocin, tell your doctor about all your medical conditions or allergies, and all the medicines you are using.

2) Methargin:

a) Drug class:Adrenergic Antagonist; Ergot; Oxytocic

b) Mechanism of action:

- Ergot alkaloid induces rapid, sustained tetanic uterine contraction that ↓3rd stage of labor and ↓blood loss.

- Administer after delivery of the placenta to ↓the risk of postpartal hemorrhage.

c) Major side effects:

- Nausea, Vomiting, Severe HTN episodes, bradycardia, ergotism.

Life threatening: Shock

d) Nursing consideration and intervention:

- Assessment: Monitor BP and uterine response during and after parenteral adm until partum period is stabilized.

- Implementation: BP suddenly increases or if there are frequent periods of uterine relaxation.

e) Health teaching:

Implementation:

BP suddenly increases or if there are frequent periods of uterine relaxation.

e) Health teaching:

Report severe cramping or ↑bleeding.

Report cold or numb fingers/toes, nausea, vomiting, chest/muscle pain.

3) Prostaglandin:

a) Drug class:Are active lipids formed from arachidonic acid and act as short-lived paracrine and autocrine messengers.

b) Mechanism of action:

- Receptor-> adenocyclase -> ADP converts ATP to cAMP - > cAMP activates protein kinase A -> and thats going to help decrease calcium levels = vasodilation (decrease smooth muscle tone)

c) Major side effects:

1. Apnea (in up to 15% of patients)

2.Thrombocytopenia

3.Fever

4.Hypoglycemia, hypocalcaemia

5. Seizure

6.Diarrhea

7. Hypotension & Bradycardia

8. lethargy

9. Cortical hyperostosis with prolonged use

d) Nursing consideration and intervention:

1. Obtain baseline vital signs, monitor ECG & BP.
2. Assess for ductal patency and for improvement in oxygenation.
3. Monitor for respiratory depression and be prepared for intubation.
4. Monitor infant’s temperature closely.
5. Maintain patient’s IV at all times. Have two IV sites to avoid interruption of PGE infusion
6. Solution compatibility : D5W, NS
7. Two RN signatures are required to verify that physician order is calculated within guidelines and
that the infusion rate is accurate.
8. All meds mixed by pharmacy have a 24hr sterility expiration.
9. Standard concentration prepared by pharmacy is 10mcg/mL in D5W or NS.

e) Health teaching:

- Inform Doctor about any allergic condition & repire any sihsi and symptoms of complication.