Duramorph Morphine Case Study
Duramorph (morphine)
Classifications: Opioid
Route: intrathecally or epiduarally. Larger doses increase the side effects without increase the length of time the drug works. Nurses don’t give this??
OB use: For pain 24 hours after birth/most commonly used with C sections.
Side Effects: pruritus, nausea and vomiting, and urinary retention
Nursing implications: works in 30-60 minutes.
Contraindications: allergy/hypersensitivity to morphine.
Maternal Side effects: most common: confusion, sedation, constipation, hypotension, pruritus, urinary retention, nausea, and vomiting.
Can cause resp depression which can cause neuro problems. Give they are obese taking mag. Sulfate or have sleep apnea are at a greater risk for resp depression. …show more content…
You can give Naloxone (Narcan) to reverse resp depression.
Nursing considerations: Make sure they don’t have an allergy to morphine when getting hx. Assess vital signs and LOS after giving. Make sure they are breathing okay. Watch voiding habits. Check pain score. If they have puritius then give lotions, backrubs, cool or warm packs admin prescribed meds prn. Have Narcan on hand at all times. Check BP. Asses pt when she ambulates for the first time. Provide assistants and watch when caring for newborn. ASSESS resp status hourly for the first 12 hours and q everyother hour for the next 12 hours.
Teaching: headaches are uncommon but can happen 2-5 days after anesthesia: sleeping in a dark room, caffeine and hydration might help.
Naloxone (Narcan)
Class: opioid antagonist
Ob Use: used to reverse the mild resp depression caused by butorphanol (Standol, nalbuphine (Nubain) and meperidine hydrochloride (Demerol), sedation, and hypotension following small doses of opiates. NOTE: this is the drug of choice when the cause of resp depression is unknown./Given to the laboring mother or newborn.
Route: To mother: may be injected undiluted at a rate of 04.mg over 15sec into the tubing of a running IV. Also can be diluted in 5% dextrose (more often in postop settings when epidurals are given for c section) For Neonates IV, IM, ET. Standard dosage is 0.01mg/kg
Contraindications: Don’t give to women of baby’s with known dependency to narcotics.
Side Effects:
Maternal/Fetal Risk:
Nursing implications: The half life is shorter then Demerol so you need to have it on hand because resp depression might return. Can cause withdrawals in women who have a dependency on narcotics. After giving direct IV maternal vial signs should be checked q5 minutes until resp depression is stabilized and then q30 minutes.
Nalbuphine Hydrochloride (Nubain)
Class: Synthetic opioid agonist-antagnoist narcotic analgesic
Ob Use: Moderate to severe pain equal to the effects of morphine
Route: IM/SQ/IV adults 10-20mg q3-6 hours.
Contraindications: hypersenstiviy to allergy of this drug.
Side Effects: sedation, clammy, sweaty skin, dry mouth, bitter taste, N/V, dizziness, vertigo, nervousness, restlessness, depression, crying, euphoria…
Maternal/Fetal Risk:
Nursing implications: assess for allergy for narcotics on admission.
Inform pt of potential side effects, check pain scale, if they are allergic to sulfate it may cause allergy, can give naloxone (Narcan) or diphenhydramine per dr orders. Asses resp rate before and after giving (if less then 12 breaths per minutes) assess urinary output and bladder distension. Help pt to walk, don’t drink on this drug, can cause withdawls if you discontinue abruptly.
Naloxone (Narcan)
Class: opioid antagonist
Ob Use: used to reverse the mild resp depression caused by butorphanol (Standol, nalbuphine (Nubain) and meperidine hydrochloride (Demerol), sedation, and hypotension following small doses of opiates. NOTE: this is the drug of choice when the cause of resp depression is unknown./Given to the laboring mother or newborn.
Route: To mother: may be injected undiluted at a rate of 04.mg over 15sec into the tubing of a running IV. Also can be diluted in 5% dextrose (more often in postop settings when epidurals are given for c section) For Neonates IV, IM, ET. Standard dosage is 0.01mg/kg
Contraindications: Don’t give to women of baby’s with known dependency to narcotics.
Side Effects:
Maternal/Fetal …show more content…
Risk:
Nursing implications: The half life is shorter then Demerol so you need to have it on hand because resp depression might return. Can cause withdrawals in women who have a dependency on narcotics. After giving direct IV maternal vial signs should be checked q5 minutes until resp depression is stabilized and then q30 minutes.
Fentanyl (Sublimaze)
Class: short acting synthetic opioid
Ob Use: moderate analgesia and mild sedation properties
Route: Usual dose is 50 to 100mg q1 hour.
Contraindications:
Side Effects:
Maternal/Fetal Risk:
Nursing implications: Main advantage is that it has rapid onset/has limited placental transfer so it is less likely to lower the fetal heart rate/Women who take this are less likely to need Narcan for their newborns/Has a short half life so it’s may need to have repeated doses/don’t give with other anesthetic agents/ need to check resp depression and cardiac status by watching vital signs closely and pulse ox/ must keep track of FHR/can be reversed by narcan
Butorphanol Tartrate (Stadol)
Class: Analgesics opioid – mixed agonist-antagonist agent
Ob Use: the analgesiac potency is 30-40 times stronger then meperidine and 7 times that of morphine. It reverses the analgesic effect of other opioids or narcotics in the woman’s body and precipitates withdrawl in drug dependend individuals
Route: In labor most freq is IV (recommened is 1-2mg/smaller dose is often used) can also be given IM (recommended is 1-2mg/2mg is most often used/onset in 10-15 minutes). Rapid onset and peaks in 30-60 minutes/duration is 3-4 hours.
Contraindications: If she is using drugs she should not get this med. If breast feeding.
Side Effects: Resp depression can occur/can be reversed by narcan. Not common but urinary retention. Need to check for bladder retention often – might need to do and in and out cath. Major side effects include somnolence, dizziness, and feeling of dysphoria.
Maternal/Fetal Risk:
Nursing implications: don’t give with other anesthetic agents/need to check resp depression and cardiac status by watching vital signs closely and pulse ox/must keep track of FHR/can be reversed by narcan
Hemabate:
Class: Oxytocics
Ob Use: to reduce blood lose secondary to uterine atony. Stimulates myometrial contractions to control postpartum bleeding that is unresponsive to usual techniques.
Route: The usual dose is IM 250mcg wich can be raeapted q1.5 to 3.5 hours if uterine atony continues. Cannot use for more then 48 hours and not to exceed 12mg (48 doses)
Contraindications: women with active cardiac, pulmonary, or renal disease. DO NOT give to women who are pregnant or with acute PID. Use caution in women with asthma, adrenal disease, hypotension, hypertension, DM, epilepsy, fibroids, cervian stenosis, or previous uterine surgery.
Side Effects: Most common is nausea/diarrhea. Fever chills and flushing can happen. Headaches, muscle, joint, abd and eye pain can happen.
Nursing implications: Give in a large muscle (make sure to aspirate) If you go into a vessel you can cause bronchospasm and tetanic contractions (?) Monitor uterine status and bleeding after giving.
Report excess bleeding to dr. check vital signs routinely. Breast freeding should be delayed for 24 hours after admin.
Methyergonovine (methergine)
Class: Oxytocic
Ob Use: Used postpartum to stimulate uterine contraction.
Route: Can be given IM or oral: has rapid onset of action. IM: 0.2mg following the birth of the placenta. Oral: 0.2 to 0.4mg works in 2-5 minutes can be repeated q2-4 hrs if needed. DON’T want to give IV because it can cause sever hypertension. Can give in a emergency.
Contraindications: don’t give if pregnant, use caution with rental/hepatic disease, cardiac problems, preeclampsia, sepsis, and lactation (may decrease prolactin levels)
Side Effects Maternal: hypertension, nausea, vomiting, headaches and uterine cramping are common.
Fetal Risk: Because it works for a long time it can cause tetanic contractions. SHOULD NEVER be given in pregnancy or before delivery of the fetus.
Nursing implications: This is a vasoconstrictive drug that effects all blood vessels, esp. large arteries. This can cause hypertension. Monitor fundal height consistency and amount of lochia, call dr if uterus is still boggy even after giving. Assess BP routinely, Tell pt that it may cause really bad cramps, Ergot toxicity?? DO not smoke on this drug, ampules are refrigerated but can be left at room temp for 60 days.
Oxytocin (Pitocin)
Class: Oxytocic
Ob Use: Used for induction in term/augment uterine contraction in the first and seoncd stage of labor/maybe used right after delivery to stim unterine contractions which controls uterine atony: increases the excitability of the muscle cells of the uterus/increases the strength of contractions.
Route: Induction: 10units 1ml to 1000ml of IV solution/resulting consentration is 10miliunit to 1ml. Start at 0.5-1milliunit/min and increase 1-2mu/min every 40-60 minutes/alternatively start 1-2mu/min and increase by 1mu/min q15minutes until good contraction are achived (2-3 minutes and lasting 40-60 seconds) to Half life 3-5mins/steady state 40 minutes/BP may initially decrease but after prolonged use it can cause BP to go up by 30% above baseline.
Contraindications: Server preeclampsia-eclampsia/pre-disposition to uterine rupture/mal-presentation or malposition/prolapse cord/preterm infant/placenta previa/presence of nonreassuring fetal status.
Side Effects Maternal: hyperstimulation of uterus can cause the following – water intoxication, rapid labor (uterine rupture), impaired uterine blood flow leading to hypoxia of fetus.
Side effects fetal: hyperbilirubinemia for augmentation of labor/hypoxia related to over contraction.
Nursing implications: explain to pt how it works/apply fetal monitor and obtain 15-20 min tracing and nonstress test of FHR before starting/for induction and augmentation start primary IV and piggyback secondary IV with oxytocin and infusion pump/max rate is 40milliunits per min/discontinue and infuse primary solution when nonreassuring FHR – contractions happen more then q2mins –duration is more the 60 secs – insufficient relaztion of uterus between contrations (also turn on side and if nonreassuring FHR continues then admin oxygen 7-10L/min/keep up with intake and output levels.
Depo- provera (DMPA):
Class: Long acting progestin contraceptives (contains no
Estrogen)
Ob Use: This is for women who cannot handle estrogen birth controls or want to breast feed, or women who forget the BC. Works by primarily suppressing ovulation. Thicken cervical mucous to block sperm/high enough levels of progesterone to block LH hormones.
Route: IM 150mg or subq 104mg works for 3 months and schedule next injection q10 -14wks. Subq may cause less pain the IM and you can do self injections this way.
Contraindications:
Side Effects: menstrual irregularities, headaches, weight gain, breast tenderness, hair loss, and depression.
Maternal Risk: can cause bone demineralization esp in the first 2 years. Bones loss slows after this and can be reversed. All women should exercise daily and 1200mg of calcium with Vitamin D.
Nursing implications: Fertility might not return for 9 months after getting off.
Magnesium Sulfate
Class:
Ob Use: the action reduces the risk for convulsions - first line drug in preeslampsia. Decreases the frequency and intensity of uterine contractions/used a tocolytic in pre perm labor.
Route: Normally IV with infusion pump for accurate dosing/can be given IM but it is irritating to tissue so it should be avoid if possible. Loading dose 4-6g over 20-30 minutes period/Maintenance dose 2-3g/hr vis infusion pump
Contraindications: diagnosed maternal myasthenia gravis/impaired kidney function due to excretion being in the kidneys.
Side Effects Maternal: Lethargy and weakness, sweating, feeling of warmth, flushing . Watch for s/s of toxicity like absence of reflexes, oliguria (low output of urine) Rapid admin of large dose can cause CARDIAC ARREST/can cause uterine atony and postpartum bleeding due to tocolytic effect.
Side Effects Fetal: readily crosses the placenta/Must watch FHR because it can cause decrease in baseline and variability.
Nursing implications: Must check serum mag levels/this drugs is excreted in the kidneys/monitor blood pressure/monitor for toxicity/monitor for resp depression/assess knee jerk for absents of reflexes/determine urinary output/monitor mag levels normally q6-8hrs/ANTAGNOIST: Calcium glucoante should be ready at bedside for resp paralysis or cardiac arrest (1g given IV over 3 minutes)/continue for 24 hours after to reduce risk for seizures post term/check newborn for 24-48 hours for toxicity levels if given close to birth.
RhoGam
Classification: Immune globulin specific for D antigen
Ob use: Give for the prevention of sensitization in Rh. Mother must be Rh- and not previously sensitized to Rh factor and baby must be Rh+. Given during pregnancy to prevent erythroblastosis fetalis if fetus is Rh +. Given in current and or future pregnancy Given postpartum to protect future pregnancies.
Route: IM and IV. DO NOT confuse which one can be used for which. Postpartum admin: one vial 3oomcg. IM (deltoid) within 72 hours of birth. May need to give more if there is significant fetal-maternal bleeding.
Contradictions: Don’t give to women that are sensitive to human immune globulins. Review mother/fetus cross match and all over labs. NEVER GIVE TO INFANTS.
Side Effects: pain at injection site, anemia, fever. May decrease response to live virus vaccines such as rubella.
Maternal Risks:
Fetal Risks:
Nursing implications: Make sure that the IM prefilled comes to room temp before giving. Do not give if you don’t know the infants blood type.
Family Teaching: Report pain at injection site to the nurse. Carry Rh information and status with her at all times.
Vitamin K (Aqua-Mephyton)
Class: prophylactic Vitamin
Ob Use: promots liver formation of the clotting factors II, VII, IX, and X.
Route: Vastus lateralis muscle 25 gauge 5/8 inch needle (remember to aspirate) one time only prophylactic dose of 0.5-1mg IM at birth or within 1hour (may be delayed until after the first breast feeding) If the mother was taking anticoagulants during pregnancy then the baby might get a second dose 6-8 hours after first dose. IM concentration: 1mg /0.5ml.
Contraindications:
Side Effects: Pain and edema at injection site/allergic reaction such as rash and urticaria can also happen.
Maternal/Fetal Risk:
Nursing implications: protect the drug for light/look for local inflmmation/look for jaundice and kernicterus esp in preterm infanct/give vit k before circumcision/watch for bleeding.
Classifications: Opioid
Route: intrathecally or epiduarally. Larger doses increase the side effects without increase the length of time the drug works. Nurses don’t give this??
OB use: For pain 24 hours after birth/most commonly used with C sections.
Side Effects: pruritus, nausea and vomiting, and urinary retention
Nursing implications: works in 30-60 minutes.
Contraindications: allergy/hypersensitivity to morphine.
Maternal Side effects: most common: confusion, sedation, constipation, hypotension, pruritus, urinary retention, nausea, and vomiting.
Can cause resp depression which can cause neuro problems. Give they are obese taking mag. Sulfate or have sleep apnea are at a greater risk for resp depression. …show more content…
You can give Naloxone (Narcan) to reverse resp depression.
Nursing considerations: Make sure they don’t have an allergy to morphine when getting hx. Assess vital signs and LOS after giving. Make sure they are breathing okay. Watch voiding habits. Check pain score. If they have puritius then give lotions, backrubs, cool or warm packs admin prescribed meds prn. Have Narcan on hand at all times. Check BP. Asses pt when she ambulates for the first time. Provide assistants and watch when caring for newborn. ASSESS resp status hourly for the first 12 hours and q everyother hour for the next 12 hours.
Teaching: headaches are uncommon but can happen 2-5 days after anesthesia: sleeping in a dark room, caffeine and hydration might help.
Naloxone (Narcan)
Class: opioid antagonist
Ob Use: used to reverse the mild resp depression caused by butorphanol (Standol, nalbuphine (Nubain) and meperidine hydrochloride (Demerol), sedation, and hypotension following small doses of opiates. NOTE: this is the drug of choice when the cause of resp depression is unknown./Given to the laboring mother or newborn.
Route: To mother: may be injected undiluted at a rate of 04.mg over 15sec into the tubing of a running IV. Also can be diluted in 5% dextrose (more often in postop settings when epidurals are given for c section) For Neonates IV, IM, ET. Standard dosage is 0.01mg/kg
Contraindications: Don’t give to women of baby’s with known dependency to narcotics.
Side Effects:
Maternal/Fetal Risk:
Nursing implications: The half life is shorter then Demerol so you need to have it on hand because resp depression might return. Can cause withdrawals in women who have a dependency on narcotics. After giving direct IV maternal vial signs should be checked q5 minutes until resp depression is stabilized and then q30 minutes.
Nalbuphine Hydrochloride (Nubain)
Class: Synthetic opioid agonist-antagnoist narcotic analgesic
Ob Use: Moderate to severe pain equal to the effects of morphine
Route: IM/SQ/IV adults 10-20mg q3-6 hours.
Contraindications: hypersenstiviy to allergy of this drug.
Side Effects: sedation, clammy, sweaty skin, dry mouth, bitter taste, N/V, dizziness, vertigo, nervousness, restlessness, depression, crying, euphoria…
Maternal/Fetal Risk:
Nursing implications: assess for allergy for narcotics on admission.
Inform pt of potential side effects, check pain scale, if they are allergic to sulfate it may cause allergy, can give naloxone (Narcan) or diphenhydramine per dr orders. Asses resp rate before and after giving (if less then 12 breaths per minutes) assess urinary output and bladder distension. Help pt to walk, don’t drink on this drug, can cause withdawls if you discontinue abruptly.
Naloxone (Narcan)
Class: opioid antagonist
Ob Use: used to reverse the mild resp depression caused by butorphanol (Standol, nalbuphine (Nubain) and meperidine hydrochloride (Demerol), sedation, and hypotension following small doses of opiates. NOTE: this is the drug of choice when the cause of resp depression is unknown./Given to the laboring mother or newborn.
Route: To mother: may be injected undiluted at a rate of 04.mg over 15sec into the tubing of a running IV. Also can be diluted in 5% dextrose (more often in postop settings when epidurals are given for c section) For Neonates IV, IM, ET. Standard dosage is 0.01mg/kg
Contraindications: Don’t give to women of baby’s with known dependency to narcotics.
Side Effects:
Maternal/Fetal …show more content…
Risk:
Nursing implications: The half life is shorter then Demerol so you need to have it on hand because resp depression might return. Can cause withdrawals in women who have a dependency on narcotics. After giving direct IV maternal vial signs should be checked q5 minutes until resp depression is stabilized and then q30 minutes.
Fentanyl (Sublimaze)
Class: short acting synthetic opioid
Ob Use: moderate analgesia and mild sedation properties
Route: Usual dose is 50 to 100mg q1 hour.
Contraindications:
Side Effects:
Maternal/Fetal Risk:
Nursing implications: Main advantage is that it has rapid onset/has limited placental transfer so it is less likely to lower the fetal heart rate/Women who take this are less likely to need Narcan for their newborns/Has a short half life so it’s may need to have repeated doses/don’t give with other anesthetic agents/ need to check resp depression and cardiac status by watching vital signs closely and pulse ox/ must keep track of FHR/can be reversed by narcan
Butorphanol Tartrate (Stadol)
Class: Analgesics opioid – mixed agonist-antagonist agent
Ob Use: the analgesiac potency is 30-40 times stronger then meperidine and 7 times that of morphine. It reverses the analgesic effect of other opioids or narcotics in the woman’s body and precipitates withdrawl in drug dependend individuals
Route: In labor most freq is IV (recommened is 1-2mg/smaller dose is often used) can also be given IM (recommended is 1-2mg/2mg is most often used/onset in 10-15 minutes). Rapid onset and peaks in 30-60 minutes/duration is 3-4 hours.
Contraindications: If she is using drugs she should not get this med. If breast feeding.
Side Effects: Resp depression can occur/can be reversed by narcan. Not common but urinary retention. Need to check for bladder retention often – might need to do and in and out cath. Major side effects include somnolence, dizziness, and feeling of dysphoria.
Maternal/Fetal Risk:
Nursing implications: don’t give with other anesthetic agents/need to check resp depression and cardiac status by watching vital signs closely and pulse ox/must keep track of FHR/can be reversed by narcan
Hemabate:
Class: Oxytocics
Ob Use: to reduce blood lose secondary to uterine atony. Stimulates myometrial contractions to control postpartum bleeding that is unresponsive to usual techniques.
Route: The usual dose is IM 250mcg wich can be raeapted q1.5 to 3.5 hours if uterine atony continues. Cannot use for more then 48 hours and not to exceed 12mg (48 doses)
Contraindications: women with active cardiac, pulmonary, or renal disease. DO NOT give to women who are pregnant or with acute PID. Use caution in women with asthma, adrenal disease, hypotension, hypertension, DM, epilepsy, fibroids, cervian stenosis, or previous uterine surgery.
Side Effects: Most common is nausea/diarrhea. Fever chills and flushing can happen. Headaches, muscle, joint, abd and eye pain can happen.
Nursing implications: Give in a large muscle (make sure to aspirate) If you go into a vessel you can cause bronchospasm and tetanic contractions (?) Monitor uterine status and bleeding after giving.
Report excess bleeding to dr. check vital signs routinely. Breast freeding should be delayed for 24 hours after admin.
Methyergonovine (methergine)
Class: Oxytocic
Ob Use: Used postpartum to stimulate uterine contraction.
Route: Can be given IM or oral: has rapid onset of action. IM: 0.2mg following the birth of the placenta. Oral: 0.2 to 0.4mg works in 2-5 minutes can be repeated q2-4 hrs if needed. DON’T want to give IV because it can cause sever hypertension. Can give in a emergency.
Contraindications: don’t give if pregnant, use caution with rental/hepatic disease, cardiac problems, preeclampsia, sepsis, and lactation (may decrease prolactin levels)
Side Effects Maternal: hypertension, nausea, vomiting, headaches and uterine cramping are common.
Fetal Risk: Because it works for a long time it can cause tetanic contractions. SHOULD NEVER be given in pregnancy or before delivery of the fetus.
Nursing implications: This is a vasoconstrictive drug that effects all blood vessels, esp. large arteries. This can cause hypertension. Monitor fundal height consistency and amount of lochia, call dr if uterus is still boggy even after giving. Assess BP routinely, Tell pt that it may cause really bad cramps, Ergot toxicity?? DO not smoke on this drug, ampules are refrigerated but can be left at room temp for 60 days.
Oxytocin (Pitocin)
Class: Oxytocic
Ob Use: Used for induction in term/augment uterine contraction in the first and seoncd stage of labor/maybe used right after delivery to stim unterine contractions which controls uterine atony: increases the excitability of the muscle cells of the uterus/increases the strength of contractions.
Route: Induction: 10units 1ml to 1000ml of IV solution/resulting consentration is 10miliunit to 1ml. Start at 0.5-1milliunit/min and increase 1-2mu/min every 40-60 minutes/alternatively start 1-2mu/min and increase by 1mu/min q15minutes until good contraction are achived (2-3 minutes and lasting 40-60 seconds) to Half life 3-5mins/steady state 40 minutes/BP may initially decrease but after prolonged use it can cause BP to go up by 30% above baseline.
Contraindications: Server preeclampsia-eclampsia/pre-disposition to uterine rupture/mal-presentation or malposition/prolapse cord/preterm infant/placenta previa/presence of nonreassuring fetal status.
Side Effects Maternal: hyperstimulation of uterus can cause the following – water intoxication, rapid labor (uterine rupture), impaired uterine blood flow leading to hypoxia of fetus.
Side effects fetal: hyperbilirubinemia for augmentation of labor/hypoxia related to over contraction.
Nursing implications: explain to pt how it works/apply fetal monitor and obtain 15-20 min tracing and nonstress test of FHR before starting/for induction and augmentation start primary IV and piggyback secondary IV with oxytocin and infusion pump/max rate is 40milliunits per min/discontinue and infuse primary solution when nonreassuring FHR – contractions happen more then q2mins –duration is more the 60 secs – insufficient relaztion of uterus between contrations (also turn on side and if nonreassuring FHR continues then admin oxygen 7-10L/min/keep up with intake and output levels.
Depo- provera (DMPA):
Class: Long acting progestin contraceptives (contains no
Estrogen)
Ob Use: This is for women who cannot handle estrogen birth controls or want to breast feed, or women who forget the BC. Works by primarily suppressing ovulation. Thicken cervical mucous to block sperm/high enough levels of progesterone to block LH hormones.
Route: IM 150mg or subq 104mg works for 3 months and schedule next injection q10 -14wks. Subq may cause less pain the IM and you can do self injections this way.
Contraindications:
Side Effects: menstrual irregularities, headaches, weight gain, breast tenderness, hair loss, and depression.
Maternal Risk: can cause bone demineralization esp in the first 2 years. Bones loss slows after this and can be reversed. All women should exercise daily and 1200mg of calcium with Vitamin D.
Nursing implications: Fertility might not return for 9 months after getting off.
Magnesium Sulfate
Class:
Ob Use: the action reduces the risk for convulsions - first line drug in preeslampsia. Decreases the frequency and intensity of uterine contractions/used a tocolytic in pre perm labor.
Route: Normally IV with infusion pump for accurate dosing/can be given IM but it is irritating to tissue so it should be avoid if possible. Loading dose 4-6g over 20-30 minutes period/Maintenance dose 2-3g/hr vis infusion pump
Contraindications: diagnosed maternal myasthenia gravis/impaired kidney function due to excretion being in the kidneys.
Side Effects Maternal: Lethargy and weakness, sweating, feeling of warmth, flushing . Watch for s/s of toxicity like absence of reflexes, oliguria (low output of urine) Rapid admin of large dose can cause CARDIAC ARREST/can cause uterine atony and postpartum bleeding due to tocolytic effect.
Side Effects Fetal: readily crosses the placenta/Must watch FHR because it can cause decrease in baseline and variability.
Nursing implications: Must check serum mag levels/this drugs is excreted in the kidneys/monitor blood pressure/monitor for toxicity/monitor for resp depression/assess knee jerk for absents of reflexes/determine urinary output/monitor mag levels normally q6-8hrs/ANTAGNOIST: Calcium glucoante should be ready at bedside for resp paralysis or cardiac arrest (1g given IV over 3 minutes)/continue for 24 hours after to reduce risk for seizures post term/check newborn for 24-48 hours for toxicity levels if given close to birth.
RhoGam
Classification: Immune globulin specific for D antigen
Ob use: Give for the prevention of sensitization in Rh. Mother must be Rh- and not previously sensitized to Rh factor and baby must be Rh+. Given during pregnancy to prevent erythroblastosis fetalis if fetus is Rh +. Given in current and or future pregnancy Given postpartum to protect future pregnancies.
Route: IM and IV. DO NOT confuse which one can be used for which. Postpartum admin: one vial 3oomcg. IM (deltoid) within 72 hours of birth. May need to give more if there is significant fetal-maternal bleeding.
Contradictions: Don’t give to women that are sensitive to human immune globulins. Review mother/fetus cross match and all over labs. NEVER GIVE TO INFANTS.
Side Effects: pain at injection site, anemia, fever. May decrease response to live virus vaccines such as rubella.
Maternal Risks:
Fetal Risks:
Nursing implications: Make sure that the IM prefilled comes to room temp before giving. Do not give if you don’t know the infants blood type.
Family Teaching: Report pain at injection site to the nurse. Carry Rh information and status with her at all times.
Vitamin K (Aqua-Mephyton)
Class: prophylactic Vitamin
Ob Use: promots liver formation of the clotting factors II, VII, IX, and X.
Route: Vastus lateralis muscle 25 gauge 5/8 inch needle (remember to aspirate) one time only prophylactic dose of 0.5-1mg IM at birth or within 1hour (may be delayed until after the first breast feeding) If the mother was taking anticoagulants during pregnancy then the baby might get a second dose 6-8 hours after first dose. IM concentration: 1mg /0.5ml.
Contraindications:
Side Effects: Pain and edema at injection site/allergic reaction such as rash and urticaria can also happen.
Maternal/Fetal Risk:
Nursing implications: protect the drug for light/look for local inflmmation/look for jaundice and kernicterus esp in preterm infanct/give vit k before circumcision/watch for bleeding.