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NR-327 Maternal-Child Nursing Chamberlain University

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Chamberlain University

NR-327 Maternal-Child Nursing Chamberlain University

DRUG NAME (brand/generic)
OB INDICATIONS
OB CONTRAINDICATIONS DOSAGE ROUTE FREQUENCY MISC. INFORMATION
Betamethasone (Celestone) Pd 586
STERIOD
Releases enzymes that produce and release lung surfactant to stimulate lung maturity in a fetus
Hypersensitivity to betamethasone Systemic infections- fungal or tb
12mg injection, 2x, 12-24 hours apart
IM Ventral gluteal or vastus lateralis muscles
2 injection dose 12-24 hours apart Administer 24-34 gestation
Pulmonary edema when given in conjunction with beta-adrenergic drugs Hyperglycemia- with pregestational or gestational diabetes Hypertension Fetal decreased breathing and body movements
Magnesium Sulfate
VITAMIN
Preterm labor Prevent and treat seizures Parenternal magnesium is used for clients who have severe hypomagnesemi a IV magnesium sulfate is used to stop preterm labor and anticonvulsant during labor and delivery
Avoid using for more then 5-7 days for preterm; avoid continuous use during active labor or within 2 hr of delivery due to potential for magnesium toxicity in newborn. Passes through the placenta, assess status of fetus
ATI: Myasthenia gravis Kidney failure Hypocalcemia
Severe deficiency 812g/day in divided does; mild deficiency 1 g q 6 hrs or 250 mg/kg over 4 hours ATI: Loading dose 4-6 g intermittent IV bolus over 15-30 mins Administer maintenance dose by continuous infusion at 2g/hr Monitor therapeutic levels (4-7mEq/L)
IM/IV Limit IV fluids to 125ml/hr Have calcium gluconate available
varies SA/E CNS: Drowsiness Resp: Decrease RR CV: Arrhythmias, bradycardia, hypotension GI: Diarrhea MS: Muscle Weakness ATI: Burning at IV site, warmth, flushing, diaphoresis Nausea and vomiting Drowsiness, headache, blurred vision, dizziness, loss of deep tendon
Chamberlain College of Nursing NR 327 Maternal Child Nursing January 2017 CLINICALS: IMPORTANT MEDICATIONS
Place patient on left side
reflexes, Maternal hypotension, bradycardia, bradypnea Altered LOC, Decreased urine output Magnesium toxicity Pulmonary edema Reduced variability of fetal HR
Calcium Gluconate
THINK VITAMIN
Should be available to reverse magnesium toxicity and prevent respiratory arrest if serum levels become high
Pregnancy Class C: Animal studies have shown an adverse effect and there are no adequate and well controlled studies in pregnant women
PO 0.5- 2 g daily IV 2-15g/day
PO 2-4 divided doses IV continuous infusion or in divided doses
SA/E CNS: HA, tingling CV: Syncope, CARDIAC ARREST, arrhytymias, bradycardia, GI: Constipation, NV
Procardia (Nifedipine)
HEART
Calcium channel blocker used for hypertension. Can be used to relax uterine contractions for preterm labor
Contraindicated in women with hypotension, heart failure or disorders that affect muscle strength Avoid concurrent with magnesium sulfate
Oral loading dose: 10-20mg Continued oral therapy: 10-20mg q 3-6 hr until contractions are rare followed by
PO Hypertension = BID or TID Preterm Labor= every 20 min until contractions are under
Maternal flushing, dizziness, headache, nausea Transient maternal tachycardia Mild hypotension Modest increase in blood glucose
Chamberlain College of Nursing NR 327 Maternal Child Nursing January 2017 CLINICALS: IMPORTANT MEDICATIONS
(suppressing preterm labor) Vasodilator
terbutaline long acting formulations of 3060mg q 8-12 hours until antepartum steroids have been administered
control levels
Labetalol
HEART
Hypertension
Pregnancy class C: Animal studies have shown risk to the fetus, there are no controlled studies in women, or studies in women and animals are not available
Initially: 100 mg 2x/ day
Maintenance: 200400 mg/day
PO/ iv 2x/day
SA/E Orthostatic hypotension Tingling sensation in skin Nausea Dizziness Nasal congestion Fatigue
Hydralazine Apresoline
HEART
Eclampsia Vasodilator that increases cardiac output and blood flow to the placenta
Caution is essential when antihypertensive medications are given to women receiving magnesium sulfate because hypotension may result reducing placental perfusion
20mg/mL ?? IM IV PO
5mg q15-20 mins no response, after 20mg use dif. therapy
Hypotension
Cervidil (Dinoprostone)
UTERUS
Prostaglandin used to promote cervical ripening and to stimulate uterine contractions
Cesarean birth, fetal distress, vaginal bleeding Use with caution with maternal history of hypotension, hypertension and asthma
CERVIDIL Vaginal Insert (10 mg)
Vaginal Insert
CERVIDIL should be removed upon onset of active labor, 12 hours or membrane rupture
Uterine tachysystole (hyperstimulation of uterine contractions)
Chamberlain College of Nursing NR 327 Maternal Child Nursing January 2017 CLINICALS: IMPORTANT MEDICATIONS
Cytotec (Misoprostol)
UTERUS
Used in clients taking long-term NSAID to prevent gastric ulcers Used in pregnancy only to induce labor by causing cervical ripening (Not FDA approved)
Women who have already had cesarean birth(s) or uterine surgery
1 quarter of 100mcg tablet (0.25mcg) Labor induction: repeat 0.25mcg q 36 hours Higher dose is more likely to cause excessive contraction which may or may not be accompanied by non reassuring fetal HR pattern
Po/ Vaginally
(oral for gastric ulcers)
Single dose for cervical ripening,
3-6 hrs for induction of labor
Hyperstimulation of uterus is major adverse effect, used in setting with fetal monitoring and emergency care are readily available.
Pitocin (Oxytocin) Read pg 309
UTERUS
Inducing labor, control postpartum bleeding Management of inevitable or incomplete abortion
Contraindicated with placenta previa, vasa previa, nonreassuring fetal heart rate pattern, abnormal fetal presentation, prolapsed umbilical cord, active genital herpes, pelvic structural deformities, invasive cervical carcinoma
Common mixtures: 15 units of oxy plus 250 ml of solution 30 units + 500ml solution 60 units + 1000ml of solution
Lower concentrations. 10-20 units +1000ml solution
IV IM
0.5-6 milliunits/min Increases to 1-2 milliunits/ mins increments q 15-40 mins
Hypersensitivity to drug, hypertonic uterine activity (tachysystole), impaired uterine blood flow, uterine rupture, abruptio placenta.
Terbutaline (Brethine)
Beta2 adrenergic agonists used to stop preterm
Cardiac disease, hypertension or preeclampsia, hyperthyroidism,
2.5-7.5mg tablet PO To delay preterm labor
PO IV
q6h S/E: pulmonary edema, dyspnea, cough, tachypnea Tachycardia

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NR-327 Maternal-Child Nursing Chamberlain University

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