NCLEX OB Drugs – Flashcards
Unlock all answers in this set
Unlock answersquestion
What is a tocolytic drug?
answer
Medications that produce uterine relaxation and suppress uterine activity in an attempt to stop uterine contractions and prevent preterm birth
question
What is a tocolytic used for?
answer
Stopping contractions of the uterus and preventing preterm birth
question
Name some tocolytic drugs
answer
indomethacin magnesium sulfate nifedipine terbutaline
question
Contraindications for tocolytic drug therapy:
answer
Maternal: severe preeclampsia, active vaginal bleeding, intrauterine infection, cardiac disease, and medical or OB condition that contraindicates the continuation of pregnancy Fetal: estimated gestational age >37 weeks, cervical dilation >4 cm, fetal demise, lethal fetal anomaly, chorioamnionitis, acute fetal distress, and chronic intrauterine growth restriction
question
Interventions for patient receiving tocolytic drugs:
answer
Position on side (preferably left) - enhances placental perfusion and reduces pressure on the cervix Monitor maternal vital signs, fetal status and labor status frequently Monitor for signs of averse effects to the medication Monitor daily weight and I&O; provide fluid replacement as indicated Offer comfort measures and provide psychosocial support to client and family
question
What is indomethacin?
answer
Prostaglandin inhibitor that relaxes uterine smooth muscle
question
Adverse effects of indomethacin:
answer
Maternal: nausea and vomiting, dyspepsia, dizziness Fetal: premature closure of ductus arteriosus Newborn: bronchopulmonary dysplasia, respiratory distress syndrome, intracranial pressure, necrotizing enterocolitis, hyperbilirubinemia
question
Nursing interventions for indomethacin:
answer
Used when other methods fail ONLY if gestational age is <32 weeks Not used in clients with bleeding potential, peptic ulcer disease, or oligohydramnios Follow agency protocol Prepare to determine amniotic fluid volume and function of ductus arteriosus before therapy and within 48 hours of dc therapy
question
What is magnesium sulfate?
answer
Central nervous system depressant that relaxes smooth muscle, including uterus; used to stop preterm labor contractions and in preeclamptic clients to prevent seizures Also used as an anticonvulsant
question
What are the uses of magnesium sulfate?
answer
Stop preterm labor and prevent preterm birth Preventing and controlling seizures in preeclamptic or eclamptic clients
question
Adverse effects of magnesium sulfate:
answer
Maternal: depressed respirations, depressed DTRs, hypotension, extreme muscle weakness, flushing, decreased urine output, pulmonary edema, serum magnesium levels >9 mg/dL Newborn: hyponatremia and sleepiness
question
Contraindications of magnesium sulfate:
answer
Heart block, myocardial damage, kidney failure
question
Nursing interventions for magnesium sulfate:
answer
Always use IV pump for administration Follow protocol of agency Monitor maternal vitals every 30-60 min Assess renal function and cardiac function DC infusion and notify provider if adverse effects occur Monitor for respirations <12/min, urine output <100 mL/4 hrs Monitor magnesium levels and report levels outside therapeutic range (4-7.5 mEq/L) Monitor DTR every hour for signs of toxicity Monitor I&O hourly Keep calcium gluconate available IV administration should not be used for 2 hours preceding delivery
question
What is the antidote for magnesium sulfate?
answer
Calcium gluconate
question
What is nifedipine?
answer
Calcium channel blocker that relaxes smooth muscles, including the uterus, by blocking calcium entry
question
Adverse effects of nifedipine:
answer
Maternal: tachycardia, hypotension, dizziness, headache, nervousness, facial flushing, fatigue, nausea Newborn: hypotension
question
Nursing interventions for nifedipine:
answer
Follow agency protocol Avoid use or use cautiously with magnesium sulfate because severe hypotension can occur Monitor for adverse effects
question
What is terbutaline?
answer
Beta adrenergic agonist that relaxes smooth muscles, including the uterus, inhibiting uterine activity and causing bronchodilation
question
Adverse effects of terbutaline:
answer
Maternal: tachycardia, palpitations, pulmonary edema, chest pain, myocardial ischemia, hypotension, tremors, hypokalemia, hyperglycemia Newborn: tachycardia, hypotension, ileus, hypocalcemia, hyperbilirubinemia, hyperinsulinemia with hypoglycemia
question
Nursing interventions for terbutaline:
answer
Monitor for adverse effects and notify provider if they occur
question
What are two corticosteroids commonly used with OB pts?
answer
betamethasone and dexamethasone
question
Why are corticosteroids used in pregnancy?
answer
To increase the production of surfactant to accelerate fetal lung maturity and reduce incidence/severity of respiratory distress syndrome
question
When are corticosteroids used?
answer
When a client is in preterm labor between 28-32 weeks gestation whose labor can be inhibited for 48 hours without jeopardizing the mother or the fetus
question
Adverse effects of corticosteroids:
answer
May decrease mother's resistance to infection Pulmonary edema secondary to sodium and fluid retention Elevated blood sugars in a diabetic mother
question
Nursing interventions for corticosteroid use:
answer
Monitor maternal vital signs and lung sounds (pulmonary edema) Monitor mother for signs of infection Monitor white blood cell count Monitor blood glucose levels Administer by deep IM injection
question
Why are opioid analgesics used in OB patients?
answer
To relieve moderate to severe pain associated with labor
question
How are opioid analgesics administered in the laboring patient?
answer
IV or IM
question
Antidotes for opioid analgesics:
answer
Naloxone (Narcan)
question
What are some of the opioid analgesics used in the OB client?
answer
meperidine hydrochloride (Demerol) hydromorphone hydrochloride (Dilaudid) fentanyl sufentanil (Sufenta) butorphanol tartate nalbuphine
question
Adverse effects of Demerol and Dilaudid:
answer
dizziness, nausea, vomiting, sedation, decreased blood pressure, flushed face, urinary retention High dose: respiratory depression, skeletal muscle flacidity, cold, clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor, and coma
question
To decrease nausea with Demerol and Dilaudid:
answer
Give with promethazine (Phenergan)
question
Things to keep in mind when giving Demerol or Dilaudid:
answer
Use cautiously in those delivering preterm Not given early in labor process because it may slow the progression of labor Not administered in advanced labor (within 60 minutes of expected delivery)
question
Adverse effects of fentanyl and sufentanil
answer
Respiratory depression, dizziness, drowsiness, hypotension, urinary retention, and fetal narcosis and distress
question
Adverse effects of butorphanol tartrate and nalbuphine:
answer
Confusion, sedation, sweating, nausea, vomiting, hypotension, sinusoidal-like fetal heart rhythm
question
Nursing interventions when using opioid analgesics:
answer
Monitor vital signs - especially respirations Monitor fetal heart rate and characteristics of uterine contractions Monitor for hypotension Assess and reassess pain Monitor for bladder distention and urinary retention Have naloxone readily available
question
What are prostaglandins and why are they used in the OB pt?
answer
Used to ripen the cervix, making it softer and causing it to dilate and efface, stimulate uterine contractions To ripen the cervix before induction, induce labor, or induce abortion
question
What are some prostaglandins that are used?
answer
Prostaglandin E1: misoprostol Prostaglandin E2: dinoprostone
question
How are prostaglandins administered?
answer
Vaginally
question
Adverse effects of prostaglandins:
answer
GI effects like nausea, diarrhea, vomiting and stomach cramps; fever, chills, flushing, headache, hypotension, tachysystole (greater than or equal to 12 uterine contractions in 20 minutes without an alteration in the FHR pattern), hyperstimulation of uterus, fetal passage of meconium
question
Contraindications of prostaglandin use:
answer
Active cardiac, hepatic, pulmonary, or kidney disease; acute PID, clients who are not indicated to deliver vaginally, fetal malpresentation, hx of c-section, hx of difficult labor or traumatic labor, hypersensitivity to prostaglandins, maternal fever/infection, nonreassuring FHR pattern, placenta previa or unexplained vaginal bleeding, regular progressive uterine contraction
question
Interventions for prostaglandin administration:
answer
Monitor maternal vitals, FHR pattern, status of pregnancy Monitor for adverse effects Have void before administration and then maintain supine Discontinue when Bishop score is greater than 8 Follow agency protocol
question
What is oxytocin used for?
answer
To stimulate the smooth muscle of the uterus and increase the force, frequency, and duration of uterine contractions. It can also promote milk let down. Induces or augments labor Controls postpartum bleeding Promotes milk let down and facilitates breastfeeding Manages an incomplete abortion
question
How is oxytocin administered?
answer
IV to induce labor Intranasal to facilitate breastfeeding
question
Adverse effects of oxytocin:
answer
Allergies, dysrhythmias, changes in blood pressure, uterine rupture, and water intoxication. If given intranasally, it can cause nasal vasoconstriction. May produce uterine hypertonicity. High doses may cause hypotension. Postpartum hemorrhage can occur and should be monitored
question
Contraindications of oxytocin:
answer
A client who cannot deliver vaginally, client with hypertonic uterine contractions, active genital herpes
question
Interventions for oxytocin:
answer
Monitor maternal VS Q15min, especially BP and HR, weight, I&O, LOC, lung sounds Monitor frequency, duration, and force of contractions, and resting uterine tone Q15min Monitor FHR Q15min and notify doctor of significant changes Use IV pump when giving Monitor dose carefully. Do not leave client unattended while giving this Stope if hyperstimulation or nonreassuring FHR Monitor for water intoxication Document everything!
question
What medications can be used to manage postpartum hemorrhage?
answer
Ergot alkaloids Prostaglandin F20
question
Whate are ergot alkaloids?
answer
Ergonovine maleate and methylergonovine maleate Directly stimulate uterine muscle, increase the force and frequency of contractions, and produce a firm tetanic contraction of the uterus Can produce arterial vasoconstriction and vasospasm of coronary arteries Administered postpartum and are not administered before the delivery of the placenta
question
Adverse effects of ergot alkaloids:
answer
Nausea, uterine cramping, bradycardia, dysrhythmias, MI, and severe hypertension. High doses associated with peripheral vasospasm or vasoconstriction, angina, miosis, confusion, respiratory depression, seizures, or unconsciousness, uterine tetany
question
Contraindications of ergot alkaloids:
answer
During pregnancy and in clients with significant cardiovascular disease, peripheral vascular disease, or hypertension
question
Interventions for ergot alkaloids
answer
Monitor maternal vitals, weight, I&O, LOC and lung sounds Monitor BP Monitor uterine contractions Assess for chest pain, headache, SOB, itching, pale or cold hands or feet, nausea, diarrhea, dizziness Assess extremities for color, warmth, movement, and pain Assess vaginal bleeding Analgesics as prescribed
question
What is prostaglandin F?
answer
Carboprost tromethamine, Hemabate Contracts the uterus
question
Adverse effects of prostaglandin F:
answer
Headache, nausea, vomiting, diarrhea, fever, tachycardia, hypertension
question
Contraindications for prostaglandin F:
answer
Asthma in the pt
question
Interventions for prostaglandin F:
answer
Monitor vitals, vaginal bleeding, and uterine tone
question
What is the Rh (D) immunoglobin (RhoGAM)?
answer
Prevention of anti-Rh(D) antibody formation most successful if administered twice at 28 weeks gestation, and again within 72 hours after delivery Should be administered within 72 hours of potential or actual exposure to Rh positive blood Used to prevent isoimmunization in Rh - clients who are negative for Rh antibodies and exposed or potentially exposed to Rh + RBC by amniocentesis, chorionic villus sampling, transfusion, termination of pregnancy, abdominal trauma, or bleeding during pregnancy or birth
question
Adverse effects of RhoGAM:
answer
Elevated temperature, tenderness at injection site
question
Contraindications for RhoGAM:
answer
Rh+ client, history of systemic allergic reaction to preparations containing human immunoglobins, newborn
question
Interventions for RhoGAM
answer
Administer by IM injection at 28 weeks gestation and again within 72 hours of delivery Never administer IV Monitor for elevated temperature Monitor injection site for tenderness
question
What is the rubella vaccination?
answer
Given sub-q before d/c from hospital to a nonimmune postpartum client Administered if rubella titer is less than 1:8
question
Adverse effects of rubella vaccine:
answer
Transient rash, hypersensitivity
question
Contraindications for rubella vaccine:
answer
Hypersensitivity to eggs
question
Interventions for rubella vaccine:
answer
Assess for allergy to duck eggs and notify provider if an allergy exists Do not administer if the client or other family members are immunocompromised
question
Why are lung surfactants used?
answer
To replenish surfactant and restore surface activity to the lungs to prevent and treat respiratory distress syndrome in the premature newborn
question
How are lung surfactants administered?
answer
Intratracheal rout
question
Adverse effects of lung surfactants:
answer
transient bradycardia and oxygen desaturation, pulmonary hemorrhage, mucus plugging, and endotracheal tube reflux
question
Interventions when administering lung surfactants:
answer
Instill through catheter inserted in ET tube, avoid suction for two hours after administration Monitor for bradycardia and decreased oxygen saturation during administration Monitor respiratory status and lung sounds and for signs of adverse effects
question
Why is eye prophylaxis used for the newborn?
answer
Preventive treatment against ophthalmia neonatorum in the NB is required by law Usually ophthalmic forms of erythromycin are prescribed because they are bacteriostatic and bacteriocidal Prophylactic measure to protect against N. gonorrhoeae and C. trachomatis
question
Adverse effects:
answer
Silver nitrate can cause chemical conjunctivitis
question
Interventions for eye prophylaxis:
answer
Clean eyes of NB before instilling meds Do not flush the eyes
question
Why is phytonadione (Vitamin K) used?
answer
The NB is at risk for hemorrhagic disorders; vitamin K is not synthesized until intestinal bacteria is present. The NB is is deficient in vitamin K for the first 5-8 days postpartum Used to prophylactically treat hemorrhagic disease of the NB
question
Adverse effects of vitamin K:
answer
Hyperbilirubinemia
question
Interventions for vitamin K administration:
answer
Protect the medication from light Administer during the early NB period Administer IM in the lateral aspect of the middle third of the vastus lateralis muscle of the thigh Monitor for bruising of the injection site Monitor for jaundice and monitor the bilirubin level
question
Hepatitis B vaccine
answer
Given IM to the NB before d/c home. This is recommended for all NB
question
Adverse effects of HBV:
answer
Rash, fever, erythema, and pain at injection site
question
Interventions for the HBV:
answer
Parental consent is needed Administer IM in the lateral aspect of the middle third of the vastus lateralis muscle If a NB is born to a mother positive for Hep B surface antigen, hepatitis B immune globulin should be given within 12 hours of birth in addition to HBV vaccine
