Analgesia
it lessen the pain but you do not lose feeling or movement (examples Tylenol, Morphine , Demerol)
Anesthetic
you have partial or complete lose of feeling/sensation (Examples Epidural , General anesthesia)
Systemic medications
it affects the body or system within the body
Does systemic medications cross the placenta (Y/N)
YES
In the latent phase, the mom is dilated many cm (early labor)?
0-4 cm
In the active phase, the mom is dilated many cm ?
5-7 cm
In the transition phase, the mom is dilated many cm?
8-10 cm
Sedative are used in which phase of labor?
latent phase
What sedative medications are given in latent stage
Secobarbital sodium (Seconal), Pentobarbital sodium (Nembutal), Zolpidem (Ambien)
Sedative medications adverse effects for mother?
Increase pain, make lethargic, and hypotensive
Sedative medications adverse effects for fetus?
decrease FHR variability, Neonatal respiratory depression, Sleepiness ,Poor suck reflex (up to 4 days)
With Phenergan is you give it IM , what method do you have to use?
Z-track method
Can you give Phenergan IV undiluted (Y/N)?
NO
Should you give Phenergan IV above the hand or below the hand ?
above the hand
Vistaril and Phenergan Adverse effects for mother?
Confusion and dizziness,Disorientation,Excess sedation,Hypotension,Tachycardia,Blurred vision,Urinary retention
Vistaril and Phenergan Adverse effects for fetus?
decrease FHR variability, CNS depression, hypotonia( flaccid), hypothermia, poor feeding
What is the average fetus heart rate?
110-160 bpm
What are the opioid Agonist used in OB?
hydromorphone hydrochloride (Dilaudid), Meperidine hydrochloride (Demerol), Fentanyl (Sublimaze), and Sufentanil( Epidural use)
Fentanyl is 50-100 times more potent than __________________?
morphine
IV Fentanyl you should inject over __ to __ minutes (too rapid muscle rigidity)
3,5
Fentanyl can cause respiratory depression (T/F)
TRUE
What disorder is contraindicated with the use of fentanyl ?
Asthma
What is the antidote for fentanyl ?
Naloxone (Narcan)
You use caution giving morphine to patients with hx of seizures and who are taking _______ ?
SSRI's
What is example of common SSRI (Selective serotonin reuptake inhibitors ) ?
Adderall
Do not give morphine if the RR is below what?
12
Observe ________ symptoms in narcotic-dependent clients?
withdrawal
What medications are the opioids with Mixed Narcotic agonist-antagonist ?
butorphanol tartrate (Stadol), nalbuphine (Nubain)
What is the dose ceiling effect?
it decrease the effectiveness of drug and increased side effects
If you reach your dose celing amount and continue to receive medication , you are more at risk for respiratory depression? (T/F)
TRUE
When given Stadol you want to make sure that mother is greater than _____ weeks gestational
37
When given Stadol you want to make sure that delivery is not anticipated within __ hours?
4
Mixed Narcotic Adverse Effects for mother?
N/V ,Sweating- flushed,Sedation,Resp depression,Vertigo,Lethargy,Headache
Mixed Narcotic Adverse Effects for fetus?
↓FHR variability,Moderate CNS depression,Hypotonia
What are Pitocin use for?
Labor induction, Labor augmentation,Postpartum hemostasis
When using Pitocin why should you avoid hyperstimulation ?
↑pain & ↓blood flow to placenta = fetal distress?
What is mother at risk for with hyperstimulation?
Uterine rupturing
_________ ONLY given via volume controlled IV pump as IVPB
Pitocin
S/S of hyperstimulation :
last longer than 90 secs, occur more frequent than every 2 mins, elevated resting tone, peak pressure above 80
You should connect ________ closest proximal port to site
Pitocin
Max dose __-__ milliunits/minute for Pitocin
20,40
What is the onset time for Pitocin?
1 minute
Taking vasopressors with Pitocin can result in ?
severe HTN
S/S of Pitocin?
HTN,Dysrhythmias,Tachysytole (6 or more ctx /20min),Uterine hyperstimulation (ctx last >2min
Adverse reaction of Pitocin ?
Seizures, Water intoxication
Water intoxication symptoms
n/v- hypotension-tachycardia- cardiac arrhythmia
fluid overload s/s
i&o , lung sounds
Life-threatening adverse reaction for Pitocin?
Intracranial hemorrhage- cardiac dysrhythmia- asphyxia- uterine rupture. Fetal: Jaundice - hypoxia NR FHR (Baseline <100 or >160)Absent variability, Late decels, Prolonged decels
nurse consideration for pitocin
Tocolytic available (terbutaline sulfate)Monitor I & O Monitor maternal VS and FHRMonitor S/S uterine rupture
S/S Uterine rupture
FHR decelerations - sudden ↑pain; loss of ctx- hemorrhage- hypovolemic shock
Methylergonovine maleate (Methergine) what should you monitor carefully ?
What should you monitor BP carefully
What are the two prostaglandins used in OB?
Misoprostol (tablet) (Cytotec),Dinoprostone vaginal insert (Cervadil)
Cytotec Adverse Reactions
Uterine hyperstimulation ,Tx with terbutaline sulfate, Chills, Fever, Vomiting ,Diarrhea
With Cervadil how long do you have to stay lying down?
30 mins to 2 hours
What is Contraindicated with Cervadil ?
ROM (Rupture of membranes), Vaginal bleeding, Placenta previa, Active genital herpes
When is magnesium sulfate used?
preterm labor / neuroprotection of fetus
Adverse Effects of magnesium sulfate?
Hot flushes/ sweating, Nausea/ vomiting, Drowsiness/ blurred vision, Headache, Ileus, Lethargy, Muscle weakness, Hypocalcemia, Shortness of breath, Transient hypotension
INTOLERABLE REACTIONS of magnesium sulfate?
Pulmonary Edema, RR < 12 per minute, Absent DTR's, Severe Hypotension, Altered LOC, Extreme muscle weakness, Urinary Output < 25-30 mL/hr, Serum Magnesium level 9mg or greater
Neonate Effects while on magnesium sulfate ?
Respiratory, depression, Hypocalcemia, Hypotonia, Lethargy
Magnesium sulfate can only be given ____ ?
IVPB
You should always should have _________ ___________ available when using magnesium sulfate?
Calcium Gluconate (1Gm of 10% solution)
What does Antenatal Corticosteroids do?
Stimulates fetal lung maturity by producing surfactant
What are the Antenatal Corticosteroids used?
Betamethesone, Dexamethesone
Adverse reactions of Antenatal corticosteroids?
Maternal infection, Pulmonary edema, Worsens maternal HTN and Diabetes
When taking Antenatal corticosteroids what should you monitor?
lung sounds and glucose
Terbutaline sulfate (Brethine) does what?
Relaxes smooth muscle
Adverse Effects of Brethine?
Fluid retention (pulmonary edema),↓urinary output, Tremors, Tachycardia, Muscle weakness, Shortness of breath, Chest pain
Beta Adrenergic Agonists (Brethine) what is contraindicated ?
Severe HTN, Uncontrolled diabetes, Migraines, History of asthma (caution)
Have ________________ available to reverse effects related to cardiovascular effects
propranolol
First line tocolytic or used after Magnesium Sulfate discontinued is what ?
Nifedipine (Procardia)
Adverse Effects of Nifedipine (Procardia)
Tachycardia, Palpitations, Hypotension, Dizziness, Peripheral Edema
Adverse effects of Indocin?
Nausea/vomiting, Oligohydramnios, ↓platelets
Adverse effects of Narcan?
Maternal hypo or hypertension, Tachycardia, Hyperventilation, Nausea/vomiting, Sweating
What is given in postpartum hemmorage?
Oxytocin (Pitocin),Methylergonovine (Methergine),Methylprostaglandin F2 (Hemabate),Misoprostol (Cytotec) , Dinoprostone (Prostin E2)