Maternity and Newborn Medications
Maternity and Newborn MedicationsI. Oxytocic medication: Oxytocin (Pitocin)Oxytocin stimulates the smooth muscle of the uterus and induces contraction of the myocardiumOxytocin promotes milk letdownRoutes of administration include intranasal, intramuscular and intravenous(IV)Minimal cervical change is usually noted until the active phase of labor is achievedB. UsesInduce or augment of laborControl postpartum bleedingPromote milk letdown and facilitate breast feeding(intranasal route)Induce or complete an abortionC. Adverse reactions and contraindicationAdverse reactions are rare but may include allergies, dysrhythmias, changes in blood pressure, uterine rupture, and water intoxication, intranasal administration may cause nasal vasoconstrictionOxytocin may produce uterine hypertonicity resulting in fetal or maternal injuryHigh doses may cause hypotension, with rebound hypertensionPostpartum hemorrhage can occur because the uterus may become atonic when the medication wears offOxytocin should not be used in a client who cannot deliver vaginally or in a client with hypertonic uterine contractions
D. interventionsMonitor maternal vital signs (every 15 minutes) especially the blood pressure and heart rate, weight, intake and output, level of consciousness, and lung soundsMonitor frequency, duration, force of contraction, and resting uterine tone every 15 minutes Monitor fetal heart rate every 15 minutes, and notify the health care provider if significant changes occur; an internal fetal scalp electrode should be used if possibleAdministered by IV infusion via an infusion monitoring device (Y-setup or stopcock is used with normal saline in the primary line); carefully monitor dose being administeredDo not leave client unattended while the oxytocin is infusingAdminister oxygen if prescribedMonitor for hypertonic contractionsStop the medication if uterine hyperstimulation or nonreassuring fetal heart rate occurs; turn the client on her side, increase the IV rate of the normal saline and administer oxygen via facemaskNotify the health care provider if uterine hyperstimulation or nonreassuring fetal heart rate occursMonitor for signs of water intoxicationHave emergency equipment availableDocument the dose of the medication and the time the medication was started, increased, maintained, and discontinuedKeep the family informed of the clients progress
II. Ergot AlkaloidsErgot alkaloids directly stimulate uterine muscle and increase the force and frequency of contractionsThe medications produce a firm tetanic contraction of the uterusThe medications produce arterial vasoconstriction and can cause vasospasm of the coronary arteriesErgot alkaloids are not administered before the delivery of the placentaThe medications may be administered by oral or intramuscular route; for IV use in an emergency either medication may be administered undilutedB. UsesPostpartum hemorrhagePostabortal hemorrhage resulting from atony or involutionC. Adverse reactions and contraindicationsErgot alkaloids can cause nauseaThe medications can cause uterine crampingThe medication can cause bradycardia, dysrhythmias, myocardial infarction, and severe hypertensionHigh doses are associated with peripheral vasospasm or vasoconstriction, angina, miosis, confusion, respiratory depression, seizures, or unconsciousness; uterine tetany can occurThe medications are contraindicated during pregnancyThe medications are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, or hypertensionD. InterventionsMonitor maternal vital signs, weight, intake and output, level of consciousness, and lung soundsMonitor the blood pressure closely, the medication produces vasoconstriction, and if a rise in blood pressure is noted, withhold the medication and notify the health care providerMonitor uterine contractions(frequency, strength and duration)Assess for chest pain, headache, shortness of breath, itching, pale or cold hands or feet, nausea, diarrhea, or dizzinessNotify the health care provider if chest pain occursAssess the extremities for color, warmth, movement, and painAssess vaginal bleedingAdminister analgesics as prescribed, they may be required because the medication produces painful uterine contractionsIII. Uterine RelaxantsUterine relaxants produce uterine relaxationRitodrine is the medication of choice to control premature laborRitodrine may be used orally or intravenouslyRitodrine usually is administered intravenously when premature labor begins; when contractions have been controlled for 12 to 24 hours, the client may be started on orally administered ritodrine the IV infusion may be removedContraction may resume when the client is on oral therapy.B. UsesRitodrine is used to halt spontaneous labor when it appears after the 20th week of pregnancy and before the thirty-sixth weekTerbutaline, primarilly used to control bronchospasm, is an alternative medication for the control of premature laborC. adverse reactions and contraindicationsRitordineRitodrine can cause heart palpitations, tachycardia, nausea and vomiting, trembling, flushing, and headacheRitodrine can cause fetal tachycardiahigh doses can cause cardiovascular symptoms and pulmonary edemaRitodrine is contraindicated in clients with preexsisting cardiac diseaseterbutalineHypokalemia, pulmonary edema, and hypoglycemia may occur if given during laborHypoglycemia may be found in neonateD. InterventionsMonitor vital signs, uterine contractions, and fetal heart rate every 5 minutes when initiating therapy every 15 to 30 minutes when the client is stable and every 4 hours when the client is taking oral maintenance dosesAn infusion monitoring devise is used when the medications are administered by the IV routeMonitor for pulmonary edema; assess lung sounds for cracklesMonitor potassium and glucose levelsInstruct the client to contact the health care provider if four to six contractions per hour occurIV. ProstaglandinsProstaglandins are potent stimulators of the myometriumDinoprostone is administered as a gel or suppository directly into the vaginaCarboprost can be administered by deep intramuscular injectionB. UsesProstaglandins are abortifacientsProstaglandins can induce abortion during the second trimester, when the uterus is resistant to oxytocinDinoprostone also is used to soften and promote dilation of the cervix to facilitate vaginal deliveryC. adverse reactions and contraindicationsSignificant gastrointestinal side effects, including diarrhea, nausea, vomiting, and stomach crampsFever, chills, and flushingAnaphylaxis, dysrhythmias, bronchoconstriction, chest pain, hypertension, and peripheral vasoconstrictionContraindicated in clients with significant cardiovascular disease or those with a history of asthma or pulmonary diseaseUterine cramping and tetany caused by high doses D. InterventionsMonitor maternal vital signs, especially the blood pressure and heart rate, weight, intake and output, level of consciousness, and lung soundsMonitor frequency, duration force of uterine contractions, and resting uterine tone frequently; palpate the fundusMonitor vaginal bleedingRemain with the client for 30 minutes after administration to monitor for anaphylaxis; signs include shortness of breath or difficulty in breathing, tachycardia, hives, tightness in the chest, or swelling in the faceMaintain client in a supine position for 30 minutes following administration of the medicationKeep side rails up; have suction machine at the bedsideAdminister antidiarrheal and antiemetic medication as prescribedV. Magnesium SulfateMagnesium sulfate is a central nervous system depressant and anticoagulantThe medication causes smooth muscle relaxationThe antidote is calcium gluconateB. UsesPrevent and control seizures and preeclamptic and eclamptic clientsTreat preterm laborC. Adverse Reactions and ContraindicationsMagnesium sulfate can cause reduced respiratory rate, decreased reflexes, flushing, hypotension, and decreased heart rateContinuous IV infusion increases the risk of magnesium toxicity in the neonateIntravenous administration should not be used for 2 hours preceding deliveryMagnesium sulfate is continued for the first 12 to 24 hours postpartum if it is used for preeclampsiaHigh doses can cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest.The medication is contraindicated in the client with heart block, myocardial damage, or renal failureThe medication is used with caution in the client with severe renal impairmentD. interventionsMonitor maternal vital signs, especially respirations, every 30 to 60 minutesCalls the health care provider if respirations are less than 12, indicating respiratory depressionAssess renal function and electrocardiogram for cardiac functionMonitor magnesium levels, for the target range is 4 to 7 mEq/L; if a rise in the magnesium level occurs, notify the healthcare providerAdminister by IV infusion via an infusion monitoring devise; carefully monitor dose being administeredKeep calcium gluconate on hand in case of a magnesium sulfate overdose, because calcium gluconate antagonizes the effect of magnesium sulfateMonitor deep tendon reflexes hourly for signs of developing toxicityTest patellar or knee jerk reflex before administering repeat parenteral doses (used as an indicator of central nervous system depression; suppressed reflex may be a sign of impending respiratory arrest)Patelar reflex must be present and respiratory rate must be greater than 16 breaths per minute before each parenteral doseMonitor intake and output hourly should be maintained at 30 ml per hour because the medication is eliminated through the kidneysVI. Meperidine hydrochlorideNarcotic analgesicAdministered by intramuscular or IV route Antidote: naloxone (Narcan) B. Use:To relieve moderate to severe pain associated with labor.C. Adverse reactions and contradictions:Meperidine can cause dizziness, nausea, vomiting, sedation, decreased blood pressure, decreased respirations, diaphoresis, flushed face, decreased urination.Meperidine may be administered with promethazine (Phenergan) to prevent nausea.High dosages may result in respiratory depression, skeletal muscle flaccidity, cold, clammy skin, cyanosis, extreme somnolence progressing to convulsions, stupor, and coma. Meperidine is used cautiously in clients delivering preterm infants.Meperidine is not administered in early labor because it may slow the labor process.Meperidine is not administered in advanced labor (within 1 hour of delivery if the neonate is to be delivered before the medication is removed adequately from the fetal circulation (may cause respiratory depression).Regular use of opiates during pregnancy may produce withdrawal symptoms in the neonate (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, and seizures).D. interventions:Monitor vital signs, particularly respiratory status; if respirations are 12 per minute or fewer, withhold medication and contact health care provider.Monitor for blood pressure changes (hypotention). Maintain in a recumbent position.Have antidote available. VII. Rho (D) IMMUNE GLOBULIN ( RhoGam) Prevention of anti-Rh(D) antibody formation is most successful if the medication administered twice: at 28 weeks of gestation and again within 72 hours after delivery. The immune globulin also should be administered within 72 hours after potential or actual exposure to Rh-positive blood; must be given with each subsequent exposure or potential exposure to rh-positive blood.The immune globulin is of no benefit once the client has developed a positive antibody titer to the Rh antigen. B. Use:To prevent isoimmunization in Rh- negative clients who are exposed or potentially exposed to Rh- positive red blood cells by transfusion, termination of pregnancy, amniocentesis, chorionic villus sampling (CVS), abdominal trauma, or bleeding during pregnancy or the birth process.C. Adverse reactions and contradictions:Elevated temperature.Tenderness on the injected side. Contradicted to Rh-positive women.Contradicted in clients with a history of systemic allergic reactions to preparations containing human immunoglobulins.Not administered to new born infants.
D. Interventions:Administer to mother by intramuscular injection at 28 weeks gestation and within 72 hours after delivery. Never administer by the IV route.Monitor for temperature elevation.Monitor injection site for tenderness.VIII. BETAMETHASONE (CELESTONE) Betamethasone is a corticosteroid.Betamethasone increases production of surfactant.
B. Use:For client in preterm labor between 28 and 32 weeks whose labor can be inhibited for 48 hours without jeopardizing the mother or the fetus.C. Adverse reactions and contradictions:Decreases mothers resistance to infection.Breast-feeding contraindicated during medication administration.D. Interventions:Monitor maternal vital signs.Monitor mother for signs of infection.Monitor white blood cell count.IX. LUNG SURFACTANTS: Beractant (Survanta), Colfosceril palmitate (Exosurf) Lung surfactants replenish surfactant and restore surface activity to the lungs.Lung surfactants are administered by the intratracheal route. B. Use:To prevent or treat respiratory distress syndrome (hyaline membrane disease) in premature infants.C. Adverse reactions and contradictions:Side effects include transient bradycardia and oxygen desaturation.Surfactants are administered with caution in those at risk for circulatory overload.
D. Interventions:Instill surfactant through catheter inserted into infants endotracheal tube; avoid suctioning for at least two hours after administration.Monitor bradycardia and decreased oxygen saturation during administration.Assess lung sounds for moist breath sounds. X. EYE PROPHYLAXIS FOR THE NEONATEErythromycin (0.5% Ilotycin) and tetracycline (1%) ophthalmic ointment or drops are bacteriostatic and bactericidal and provide propylaxis against Neisseria gonorrhoeae and Clamidiya trachomatis.Silver nitrate (1%) solution may be prescribed, but its use is minimal because it does not protect against chlamydial infection and can cause chemical conjunctivitis.Preventive treatment of gonorrhea is required by law. B. Use:As a prophylactic measure to protect against Neisseria gonorrhoeae and chlamydia trachomatis.C. Adverse reaction Silver nitrate (1%) solution can cause chemical conjunctivitis.D. InterventionsCleanse the neonates eyes before instilling drops or ointment. Instill into each of the neonates conjunctival sacs within 1hour after delivery; eye prophylaxis may be delayed until an hour or so after birth to facilitate eye contact and parent-infant attachment and bonding.Do not flush the eyes after installation. XI. VITAMIN K (AquaMEPHYTON) Vitamin K is necessary for aiding in the production of active prothrombin.Newborns are deficient in Vitamin K for the first 5 to 8 days of life because of the lack of intestinal flora that is necessary to absorb Vitamin K. B. Use:For prophylaxis and to treat hemorrhagic diseases of the newborn. C. Adverse reaction:Vitamin K can cause hyperbilirubinemia in the newborn. D. InterventionsProtect the medication from light. D. InterventionsProtect the medication from light.Administer during early neonatal period.Administer in the vastus lateralis muscle of the thigh. Monitor for bruising at the injection site and for bleeding of the cord.Monitor for jaundice and monitor bilirubin level because the medication can cause hyperbilirubinemia in the newborn.
