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- Fat Soluble Vitamin
- Uses: Prevention of hemorrhagic disease of the newborn
- Rationale: At birth, bowel does not harbor the bacteria necessary to synthesize Vit K needed for coagulation
- Dosage:0.5-1 mg IM in vastus lateralis with 25-26 gauge ½”-5/8 ” needle during 1st day of life.
ERYTHROMYCIN OPHTHALMIC OINTMENT
Indications: Eye Prophylaxis against infection
Required by Law in the U.S. since newborns at risk for eye infection due to organisms present in the vagina (Opthalmia neonatorum)
Effective against gonococcus & chlamydia.
AgNo4 & TCN also used, but EES more effective against chlamydia & should be done within 2 hrs after birth.
Administration: Instill in conjunctival sac; Gently open eyelids and place thin bead of ointment at least ½ inch long. Carefully manipulate lids to spread med. Repeat in other eye. Throw away after use. After 1 minute, excess may be wiped off.
Side Effects: May cause chemical conjunctival that lasts 24-48 hrs.Vision may blur temporarily
HEPATITIS B VACCINE
(RECOMBIVAX HB - PRESERVATIVE FREE)
- Provides immunity to Hepatitis B.
- Induces protective antibodies in 95-99% of health infants who receive the recommended 3 doses. Duration of protection is unknown,
AAP recommends vaccination of all newborns but MUST HAVE PARENT PERMISSION.
- Dosage: 5mcg/0.5 ml IM in VL with 25-26 gauge ½-5/8inch needle.
- Given before discharge from hospital, at one month, and at six months.
Document site, lot number, and expiration date.
- Side Effects: Soreness at injection site, Urticaria, erythema, swelling
- Headache, fever, nausea, vomiting
Indications: Labor induction or augmentation, facilitation of threatened abortion, postpartum control of bleeding after expulsion of placenta. Nasal spray to facilitate milk let down reflex.
Actions: Stimulates uterine smooth muscle to contract; Stimulates let-down reflex by breasts; Has ADH and vasopressor effects
Rapidly metabolized by liver & kidneys. Half life only 3-9 minutes.
Contraindications & Precautions: Hypersensitivity, CPD
Adverse Effects:Seizure, coma with IV use, Water intoxication, increased BP, Tetanic uterine contractions in labor with decreased blood flow to placenta, abruptio.
- Magnesium sulfate OR Brethine is the antidote if needed. It relaxes the uterus.
- Route and Dosage:
- For labor induction/augmentation
- 1-2millunits/minute until contractions 2-3 minutes apart ( no more than 5 in 10 minutes)
Goal is contractions q 2-3 minutes, lasting 45-60 seconds with at least 30 seconds interval between each contraction
if Contractions exceed 5 in 10 minutes, last longer than ninety seconds or if fetal distress occurs.
Infusion pump always used & is piggybacked into solution so can be stopped prn.
Contractions and FHT
- Add 10 Units to 1000 cc NS
- 1 milliunit = 6 cc hr
- 2 miliunits = 12cc hr
- 3 millliunits = 18cc hr
- 4 milliunits = 24 cc hr
- 5 milliunits = 30 cc hr ETC……
Usually maximum is 20 milliunits per hour
. Watch closely for fetal distress
Used as anesthetic agent for epidural anesthesia
- Anesthetic (Produces local anesthesia by inhibiting Na + flux across nerve cell membrane.)
- High potency and slow onset. Long lasting
500-1000 cc IV bolus prior to epidural
CRNA inserts plastic epidural catheter between L3-L4 or 5 then test dose done.
Marcaine gives excellent sensory and little motor block.
Can be done at 3-4 cm dilation & Can give block that lasts ½ - 2 hours. Nurse will need to bolus but can also do continuous epidural drip via pump.
Side Effects: Maternal decreased BP most frequent. Can decrease blood flow to baby.
After epidural BP Q 2-5 minutesX 30 minutes. Ephedrine given prn.
- Signs and symptoms Toxic Levels
- Metallic taste, peri-oral numbness, tinnitus
Alpha and Beta adrenergic agonist
Use in OB to manage hypotension associated with regional anesthesia ( epidurals)
Dosage 5 mg IV push, may repeat q15min up to 20 mg in OB patients
Side Effects: Hypersensitivity, dizziness wheezing, palpitations, increased HR, and increased CO and increase in coronary artery, cerebral and muscle blood flow.
Nursing: Document lung sounds. BP and P q 2-5 minutes during IV administration
Narcotic (opiate) antagonist
Reverses effects of narcotics by displacing them from opiate receptor sites.
Used for narcotic induced respiratory depression.
Side Effects: May cause withdrawal in addicts
Monitor respiratory status carefully. May wear off before opiate does. Narcan lasts 1-4 hrs.
- Dose/Adm: Adult IM/SQ 0.4-2 mg. May repeat in 2-3 min prn X 2
- Newborn: 0.1 mg/kg IV umb vein or IM/SQ May repeat q 2-3 min X3
Centrally acting analgesic with mixed narcotic agonist and antagonist action. Can precipitate withdrawal in addict.
Used for pain during labor.
Dosage 0.5-2 mg IV q 3-4 hrs prn.
Contraindications: Narcotic addiction
Side Effects: Most important is respiratory depression.
A live attenuated virus vaccine against rubella which effectively induces rubella antibodies in 97% or more.
Dosage: 0.5 cc SQ
Contraindications: Pregnancy, Pregnancy should be avoided for at least 3 months.Allergy to neomycin. Febrile illness, allergy to eggs.
Defer at least 3 months after RhoGam or other gamma globulin.
Adverse reactions/SE:Stinging at injection site, Rash, fever 7-10 days later (Women – chronic arthritis which may persist for months or rarely years.) Very Rare- encephalitis
Postpartum women who are non-immune should be given vaccine before discharge. VIS given and consent should be signed.
Document site, lot number, expiration date.
Oxytocic ( Ergot alkaloid derivative)
Stimulate uterine contraction and decreases postpartum bleeding.Used for postpartum or post abortion bleeding.
Dosage: 0.2 mg q 2-4 hours. IV Maximum 5 doses. May follow with po prn 0.2mg q 6 hours X 2-7 days
Dilute IV doses with 5 cc NS and give slowly over 1 minute. IV route can cause severe hypertension
NEVER USED FOR INDUCTION OR AUGMENTATION OF LABOR!!!!!!!!!!
Contraindications: Hypersensitivity, heart disease, threatened AB, hypertension.
Side Effects: Uterine cramping, hypertension, leg cramps, water intoxication.
(Rh (D) Immune Globulin)
Immunoglobulin ( A blood product)
Causes destruction of any fetal RH pos RBCs that might have entered maternal circulation before the Rh negative mother has time to build up antibodies that will destroy the rbcs of future RH + fetuses.
Given IM within 72 hours to RH negative mother after termination of pregnancy with RH positive baby. (delivery or abortion). Also given prophylactically at 28 weeks gestation ( minidose)
Contraindications: Hypersensitivity, previously sensitized mothers,
Side Effects: Lethargy, myalgia, local stiffness, tenderness at site, Anaphylaxis.
Type and cross match neonatal cord blood b/c mother must be Rh negative and not previously sensitized.
Baby must be Rh positive with negative direct Coombs
2 RNs must check lot number, sign document together. Blood consent may have to be signed.
Must be administered with 72 hours after termination of pregnancy.
(Witch hazel pads)
Apply pads as needed. Change with each void, BM, or when dry.
- Causes decreased swelling & is used for episiotomy pain, hemorrhoids, perianal irritaion.
Benzocaine Spray or Ointment (Americaine, Dermaplast)
- Local anesthetic used for localized pain such as episiotomy or hemorrhoids.
- Apply to area as needed. If ointment used, remove and clean prior to reapplication. Should not be used over 1 week.
- Contraindications: Hypersensitivity
- Side Effects: Itching, rash, (allergic reaction)
(Dinoprostone, Cervidil Insert, Prepidil gel)
- Cervical ripening agent; Used for preinduction cervical ripening before oxytocin induction of labor. Can also initiate contractions.
- Cervidil placed in posterior fornix
- Prepidil Gel placed in cervical canal just below internal cervical os
- Usually left in 12 hours.
- Oxytocin started at least 30 minutes after removal.
- Adverse Reactions: headache, nausea, diarrhea, fever, hypotention, hyperstimulation of uterus with fetal distress.
Prostaglandin E1, PGE1
- Used like Cervidil Tablet placed in posterior fornix Adverse reactions; Same as cervidil
- Beta2 selective adrenergic agonist (tocolytic)
- Actions: Asthma – bronchodilator
- Pregnancy – relaxes the pregnant uterus
- Contraindications: Hypersensitivity
- Tachyarrhythmias or tachycardia
- Caution with diabetics
- Dosage: Loading dose – 5 mg po with 0.25 mg SQ Maintenance dose – 2.5-5 mg q2-4h, or 0.1-0.25mg SQ q1-3h
- Side Effects:Nervousness, anxiety, tremor, insomnia, HA, Tachycardia – maternal & fetal, palpitations, hypertension; N&V, Pulmonary edema, SOB, Chest pain
- Lab values: Elevated glucose levels, Decreased K+ levels
- Interventions: Monitor lab values and encourage pt. to increase intake of K+ rich foods. Assess for labor contractions and reduction. Assess HR and FHT before each dose. Omit if HR >120, FHR >180.
- Must be taken around the clock to be effective!!!
- Assess for respiratory problems (lung sounds, etc)
- Antidote: B2-adrenergic blocker
- Anticonvulsant, Tocolytic (Decreases acetylcholine release and depresses the CNS to act as anticonvulsant. Also decreased uterine contractions)
- Used to prevent and control seizures in preeclampsia and prevention of uterine contractions in preterm labor. Also counteracts Pitocin.
- Dosage: IV bolus loading dose (piggy back) of 4-6 grams over 20-30 minutes followed by continuous infusion of 1-2 grams per hour with an infusion pump.
- Drug excreted by kidneys.
- Adverse Reactions: Flushing, sweating hypotension, depressed deep tendon reflexes, CNS depression, respiratory depression
- Monitor P, BP, RR, UO, LOC, DTRs, and heart &breath sounds q 1 hour.
- Stop if: RR<12, UO <30cc/hr, Absent DTRs,
- Antidote Calcium gluconate. MUST HAVE Suction and O2 in room
- Given to reverse Magnesium sulfate toxicity
- Dosage: 1 mg (10 ml) of 10% solution IV over 2 minutes