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Ataractics: There are 2. What are they used for? Side effects?
- Vistaril & Phenergan
- Does not relieve pain but reduces anxiety and potentiates opiod analgesic effects.
- Is used to decrease nausea and vomiting.
- Is used for the antiemetic effect when conbined with opiods (allows for smaller doses)
- Causes sedation, dry mouth, and reduces apprehension.
- May contribute to maternal hypotension and neonatal depression.
- Fetal effects include CNS depression. Antihistamine effects
Corticosteriod: bethamethasone (Celestone)
Dosages? What is it for? What point in gestation can it be given? Side effects? Nursing mgmt?
- -12mg IM every 24 hours X 2 doses
- - To be given to pregnant women b/w 24-34 weeks gestation @ high risk for preterm delivery
- - Edema, HTN, intraocular pressure elevation, headache, & nausea.
- Monitor mother & infant for s/s of infection, hyperglycemia, HR changes, & pulmonary edema. NOT FOR IV ADMIN. Education regarding benefit of medication for neonate.
Prostaglandin: dinoprostone (Cervidil)
- -Vaginal insert used to "ripen cervix"
- -Not for use in pregnant women with previous uterine scars (ex: c-section) for risk of uterine rupture.
- -Softens and dilates the cervix
- -Provide emotional support, administer pain medication as needed, frequently assess degree of effacement & dilation, monitor uterine contractions forfrequency/furation/strangth, assess maternal vital signs, & FHR pattern frequently & monitor woman for possible adverse effects such as HA & NVD.
- IV or IM (not for elective labor induction)
- Acts on uterine myofibrils to contract as to initiate or reinforce labor
- natural hormone in hypothalamus secreted by pituitary
- IV infusion via pump, increasing dose based on protocol until adaquate labor process is achieved
- Assess baseline vital signs and FHR & then freq. after initiating oxytocin infusion
- Determine freq., duration, & strength of contractions frequently
- Notify healthcare provider of any uterine hypertonicity or abnormal FHR patterns
- Maintain careful I & O, being alert for water intoxification
- Keep client informed of labor progress
- Monitor for possible adverse effects such as hyperstimulation of the uterus, impaired uterine blood flow leading to fetal hypoxia, rapid labor leading to cervical lacerations or uterine rupture, water intoxification (if oxytocin is given in elecrtolyte free solution or at a rate exceeding 20 mU/min) and hypotension
- Bishop's score >8 to administer drug (manage pain, maternal/fetal status (esp. cervical change) and I&O
- Antidiuretic effect
- IV or IM
- Given to reverse the CNS depression as a result of opiods that were administered for labor pain
- It is a competitive opiodantagonist
- Monitor for possible side effects of (tachycardia, seizures, and tremors)
Opiods: Morphine, Demerol, and Fentanyl
- Decreases the transmission of pain impulses by binding receptor sites pathways that transmit pain signals to the brain
- Relief of moderate to severe pain
- Monitor for possible side effects of:
- Maternal - N&V, pruritis, delayed gastric emptying, drowsy, and hypoventilation
- Newborn - respiratory depression, decreased alertness, delay in suckling/feeding
Tocolytics: Terbutaline (brethine) & Nifedipine (procardia)
- Indicated for pre-term labor
- Relaxes bronchia/uterine muscle by stimulating beta2 receptors
- brethine (Terutaline) PO, IV, SQ - monitor for adverse side effects such as, nervousness, tremors, palpitations, arrhythmias, flushing - New FDA warning
- procardia (Nifedipine) usu. always PO -calcium channel blocker across cardiac and smooth muscle cells, decreases contractility and oxygen demand; monitor for adverse side effects such as flushing, palpitations, dizzy, and nervousness
Corticosteroids: betamethasone (Celestone)
- 12 mg IM q24hrs X 2 doses
- For fetl lung maturation
- To be given to pregnant women b/w 24-34 weeks gestation@ a high risk of pre-term delivery
- Not for IV admin
- Can cause edema, HTN, intraocular pressure elevation, headache, and nausea
- Nursing mgmt - monitor for s/s of infection and pulm edema
- Education regarding benefit of medication for neonate