Nurs-134 Medication Research Fa2010

8/8/2019 Nurs-134 Medication Research Fa2010

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Postpartum Medications - Mother

Name, dose, route,

frequency

Class, Action of drug

and why ordered for

this patient

Potential Side Effects Patient assessments

needed before

administering

How will you know this

drug is effective for this

patient

Patient teaching you

need to do

Ibuprofen (Motrin)

Doses:

400 mg q_4__ hours600 mg q_6___ hours

800 mg q_6___ hours

prn

Class:NSAID, nonopiate analgesic,

antipyretic

(Skidmore,487)

Action: Decreases Cox-1 and Cox-2 enzymes

necessary for

biosynthesis of

prostaglandin.

Analgesic, anti-

inflammatory,

antipyretic. (Skidmore,

487, Adams 726)

Why: Mild to moderatepain, inflammation.(Murray & Mckinney,

408)

The most common side

effects from ibuprofen

are GI related, which

include nausea, vomiting,diarrhea or constipation,

anorexia, and heartburn.

(Adams, 726)

*Assess current

medications being taken.

- oral anticoagulants are

taken d/t an increased risk

of bleeding

-Use with other NSAIDs

or corticosteroids may

increase risk of serious GI

symptoms

(Adams, 726)

*Assess for GI symptoms

such as nausea, vomiting,

or diarrhea (Murray &

McKinney, 408)

*Assess for infection-may

mask symptoms

(Skidmore, 488)

*pt will report a

reduction in pain within

one hour.

*A reduction in

inflammation or

temperature will be

noted.

(Adams, 726)

*Take PO with food or

milk. (Murray &

McKinney, 408)

*Advise pt to avoid

alcohol, salicylates,

and other NSAIDs r/t

an increased risk of GI

bleeding. (Skidmore,

488)

*Advise pt to notify

HCP of hematemesis,

tarry stools or coffee

ground vomit. (Adams,

726)

Acetaminophen (Tylenol)

325-500 mg po q 4-6 hours

prn

*Nonopioid analgesic,

antipyretic (Adams, 729)

*Inhibition of COX in

CNS; no peripheral nerve

action.

*Mild to moderate pain

(Murray & McKinney,408)

*Within recommended

dosing limits,

acetaminophen usually

produces few side effects.

(Adams, 730)

*May cause

hepatotoxicity withoverdose or long term use

(Skidmore, 38)

*Assess pts current drug

hx for any other Rx or

OTC meds that contain

acetaminophen to

calculate total dosing.

(Adams, 730)

*Assess patient for typicalalcohol use to avoid an

increased risk of

hepatotoxicity. (Adams,

730)

*Pt will report a


one hour. (Adams, 730)

*Do not take with

alcohol d/t increased

risk of liver damage.

(Adams, 730)

*Report any signs of

hepatotoxicity, such as

jaundice, yellowing ofeyes, clay-colored

stools, or dark urine.

(Adams, 730)

Oxycodone (Percolone)

5 mg. po q __4___hours

prn (Murray &

McKinney, 408)

* Opiate analgesic

(Skidmore, 718)

*Fill receptor mu and

kappa receptor sites in

CNS which blocks

*CNS sx-drowsiness,

dizziness, confusion,

H/A, sedation, euphoria.

*GI sx-nausea, vomiting,

anorexia, constipation,

*Assessment of pain on

scale.

*Assessment of VS, LOC,

allergies, and time of last

dose.

*Pt will report a


one hour. (Adams, 438)

*Inform HCP if pain

rating increases.

*Immediately report

SOB, dyspnea,

vomiting, dizziness

1st Year Nursing \NURS-134 TraditionalNURS-134 Medication Research FA2010.doc

1


2/15


Name, dose, route,

frequency


and why ordered for

this patient


needed before

administering



patient


need to do

afferent

neurotransmitters

conveying pain. (Adams,

438)*Moderate pain (Murray

& McKinney, 408)

cramps.

*Respiratory depression.

(Skidmore, 719)

(Adams, 438) upon standing.

*Make position

changes slowly.

(Adams, 439)

Oxycodone 5 mg. and

Acetaminophen 325 mg

(Percocet)

1-2 tablets po q 4-6 hours

prn

Docusate (Colace)

100 mg. po BID

*Laxative, emollient

(Skidmore, 324) Stool

softener (Adams,1030)

*Permits easier mixing offats and fluids in

intestines/fecal mass,

detergent like action

(Murray & McKinney

395)

*Prevention of

constipation in

postpartum period-

especially helpful for

patients with episiotomy.

(Murray &

McKinney,395; Adams,

1031)

*Anorexia, cramps,

diarrhea. (Skidmore,

325)

*Allergies, last BM *Pt will have a BM

usually within first 2-3

days postpartum.


*Take tabs or caps

with 8oz of liquid on

an empty stomach for

better results.(Skidmore, 325)

*Discuss with pt that

adequate fluid

consumption and

ambulation is

necessary for adequate

bowel function.

(Skidmore, 325)

Glycerin/Witch Hazel

topical pads (Tucks)

*Hemorrhoidal astringent

*Astringent

*Temporary relief of

localized itching and

discomfort r/t

hemorrhoids.

(Drugs.com)

*Rectal bleeding

(drugs.com)

*Rectal bleeding

(drugs.com)

* Assess size of

hemorrhoids.

*Temporary relief of

localized itching and

discomfort r/t

hemorrhoids.

(Drugs.com)

*Instruct pt to clean

area with water before

use and do not reuse

pad after application.

(drugs.com)


2


3/15


Name, dose, route,

frequency


and why ordered for

this patient


needed before

administering



patient


need to do

Hydrocortisone-pramoxine

topical (Proctofoam-HC)

q6 hours prn hemorrhoids

*Pramoxine-Anesthetic;

Hydrocortisone-

corticosteroid

*Promoxine-interfereswith pain signals to the

brain; hydrocortisone-

reduces chemicals in the

body that cause

inflammation.

*Used on rectal area for

relief of inflammation on

itchiness.

(drugs.com)

*Allergic reaction-

uticaria and dyspnea

*Blurred vision, H/A,

sore throat, burning andirritation at area of

application, rectal

bleeding.

(drugs.com)

*Assess pt hx for known

allergies to steroids or to

anesthetic agents

(drugs.com)

*Relief of rectal

inflammation and

itchiness

(drugs.com)

*Wash perineumbefore application.

Ferrous Sulfate

300-325 mg. po BID

*Hematinic

*Replaces iron stores in

red blood cells.

*Iron deficiency anemia

and prophylaxis in

pregnancy

(Skidmore, 403-404)

*GI sx: Nausea,

constipation, epigastricpain, black and red tarry

stools.

(Skidmore, 404)

*Baseline hemoglobin

studies (Skidmore, 404)

*Improvement of Hct,

Hgb, reticulocytes.

*Pt reports decreased

fatigue and weakness.

(Skidmore, 205)

*Less GI discomfort if

taken with meals.(Murray & McKinney,

671)

*Take with Vitamin C

for better absorption.

(Murray & McKinney,

671)

*Encourage dietary

intake of iron-

meat,dark green leafy

vegetables, beans,

eggs. (Skidmore, 405)*Increase water intake,

bulk and activity for

constipation before

laxative use.

(Skidmore, 405)

Ketorolac (Toradol)

15-30 mg IV q6 hours

10 mg po q 4-6 hours

*NSAID, nonopioid

analgesic.

*Decreases enzyme

necessary for

prostaglandin synthesis

*CNS-dizziness

*GI-nausea, flatulence,

diarrhea, GI bleeding

(Skidmore, 530-531)

*Increased effects of

*Review current

medications for

anticoagulant use (Murray

& McKinney, 408)

*Assess for hx of aspirin

*Pt will report a decrease

in pain. (Skidmore, 532)

*Take PO with food or

milk to decrease GI

discomfort. (Murray &

McKinney, 408)

*Notify HCP for


3


4/15


Name, dose, route,

frequency


and why ordered for

this patient


needed before

administering



patient


need to do

in inflammation.

(Skidmore, 531)

*Mild to moderate pain.


anticoagulants. (Murray

& McKinney, 408)

sensitivity.

*Monitor for location of

pain and ROM 1hr before

administration.(Skidmore, 532)

bleeding, bruising,

fatigue, malaise.

(Skidmore, 532)

Simethicone (Mylicon)

80 mg (chewable tablet)

po pc and bedtime prn gas

*Antiflatulent

*Lowers surface tension

of gas bubbles, and

disperses/prevents gas

pockets in GI system.

(Skidmore, 871)

*Flatulence and

abdominal distention.

(Murray & McKinney,

408)

*GI-nausea, vomiting,

abdominal craming,

diarrhea.

(Adams, 1021)

*Identify reason for

excess gas, assess bowel

sounds. (Skidmore, 871)

*Absence of flatulence.

(Skidmore, 871)

*Relief of distension.

(Murray & McKinney,

408)

*Encourage

ambulation. (Murray

& McKinney, 408)

*Take after meals and

HS. (Skidmore, 871)

Ondansentron (Zofran)

4 mg. IVPB q6h prn

*Antiemetic

*Blocks serotonin in

PNS, CNS, and small

intestine to prevent

nausea and vomiting.

(Skidmore, 707)

*Postoperative nausea

and vomiting.

(Murray & McKinney,

408)

*CNS-headache

*GI-diarrhea, abdominal

pain.

*Musculoskeletal pain,

shivering, urinary

retention, orthostatic

hypotension, flulike sx.

(Skidmore, 707; Adams,

1043.)

*Assess for absence of

nausea or vomiting before

administration.

(Skidmore, 707)

*Absence of nausea and

vomiting. (Skidmore,

707)

*Inform pt reason for

administering, and

expected result.

*Instruct pt to report

GI sx, changes in

respirations, rash or

irritation at injection

site.

(Skidmore, 708)

Diphenhydramine

(Benadryl) 25 mg. IVP

q 6h prn itching

*1st generation, non

selective antihistamine

*Competes with

histamine for H1-receptor

site in blood vessels, GI

and respiratory system to

decrease allergic

response.

(Skidmore, 315)

*Itching after epidural

*Dry mouth, dizziness,

drowsiness, headache,

nausea, vomiting,

thickened bronchial

secretions, urinary

retention.

(Murray & McKinney,

408; Adams, 1265)

*Assess respiratory

status-may cause

increased CNS

depression.

(Skidmore, 317)

*Absence of itching.

(Murray & McKinney,

408)

*Caution pt to request

assistance with

ambulation d/t

dizziness.

*Consult physician if

breastfeeding; may be

contraindicated.

(Skidmore, 316)


4


5/15


Name, dose, route,

frequency


and why ordered for

this patient


needed before

administering



patient


need to do

opioids. (Murray &

McKinney, 408)

RhO(D) Immune Globulin(RhoGAM)

One standard dose

(300mcg) IM within

___72__hours after

delivery

*Concentratedimmunoglobins, for RBC

antigen Rho(D)

*Suppresses immune

reaction in the Rh-

negative mother to Rh-

positive antigen blood of

a newborn. Prevents

hemolytic disease in

future pregnancies.

*Prevention of immune

reaction to Rh antibodies,hemolytic disease.

(Murray & McKinney,

649)

*Local pain atintramuscular site

*Fever

(Murray & McKinney,

649)

*Blood typing of motherand cord blood.

Administer if mother is

Rh-negative and newborn

is positive, or if uncertain

of newborn type.

(Murray & McKinney,

649)

*Assess for previous

reactions to

immunizations and

previous immunizationswith this product.

(Skidmore, 838)

*Prevention oferythroblastosis fetalis in

subsequent deliveries.

(Skidmore, 838)

*Teach patient reasonfor RhoGAM

administration, how it

works, and need for

future administration

in Rh positive

deliveries.

(Skidmore, 838)

Rubella Virus Vaccine

Entire volume of single-

dose vial subcutaneously

*Attenuated live virus

vaccine

*Causes formation of

antibodies against the

rubella virus by

producing a modified,

not communicable

rubella infection.*Administered to

pregnant or postpartum

mothers whose antibody

screen does not show

immunity to rubella to

prevent rubella infection

and severe congenital

defects in subsequent

pregnancies.

(Murray & McKinney,

400)

*Transient stinging at

injection site

*Fever

*Lymphadenopathy

*Arthralgia

*Transient arthritis


*Assess pt hx for

immunosupression,

sensitive to neomycin or

eggs, respiratory tract or

febrile infection, active

TB, or conditions that

affect bone marrow or

lymphatic system as

vaccine may be

contraindicated.

(Murray & McKinney,

400)

*Immunity to rubella

virus.

*Pt should be

cautioned to avoid

pregnancy for at least

4 weeks after

administration.

(Murray & McKinney,

400)


5


6/15


7/15

Labor and Delivery Medications - Mother

Name, dose, route,

frequency


and Why ordered for

this patient

Potential Side Effects Patient assessments, i.e.,

V.S. or lab values



patient


need to do

Dinoprostone (Cervidil)

10 mg. vaginal insert

q12 hours x2

*Oxytocic, abortifacient.

(Skidmore, 313)

*Myometriumstimulation to stimulate

uterine contractions and

cervical dilation.

(Skidmore, 313)

*Cervical ripening, Labor

induction (Murray &

McKinney, 364)

*GI-nausea, vomiting,

diarrhea

*Leg cramps, jointswelling, headache.

(Skidmore, 314)

*Fetal bradycardia.

*Assess for fever after

administration.

*Assess dilatation,effacement, fetal heart

tones, hypertonous

contractions lasting

longer than one minute.

*Assess respiratory rate

and rhythm, BP and

pulse-notify physician

immediately for

abnormalities after

administration.

*Assess forhypersensitive reaction-

dyspnea, rash.

(Skidmore, 314)

*Cervical ripening,

progression of labor.

(Skidmore, 314)

*Explain purpose of

administration and

expected result.*Advise pt to remain

supine for 10-15

minutes after insertion

of suppository.

*Instruct to inform

nurse or physician

immediately for

contractions that last

longer than one

minute.

(Skidmore, 314)

Magnesium Sulfate

2 Grams/hour IV (for

woman with Gestational

HTN or PTL)

*Electrolyte,

anticonvulsant, laxative,

tocolytic.

(Skidmore, 581, Murray

& McKinney, 712)

*Increases osmotic

pressure, draws fluid into

colon; relaxes uterineactivity. (Skidmore, 581,

Murray & McKinney,

713)

*Management of

pregnancy HTN and

prevention of seizures;

tocolytic. (Murray &

McKinney, 713)

*Fluid overload,

electrolyte imbalances-

potential to cause

pulmonary edema and

cardiac dysrhythmias.

*Depression of deep

tendon reflexes

*Respiratory or cardiacdepression

*Lethargy, weakness,

visual blurring, H/A,

sensation of heat,

constipation.

*Reduced fetal heart rate,

fetal-neonatal hypotonia.

(Murray & McKinney,

712-714)

*Assess VS, heart and

lung sounds hourly

*Monitor I&O ratio

*Check bowel sounds

Q4-8 hrs

*Serum magnesium levels

*Electronic fetalmonitoring

(Murray & McKinney,

713-714)

*Absence of HTN related

seizures

*Inhibition of preterm

labor

(Murray & McKinney,

712-713)

*Explain to pt reason

for administration and

expected outcome.


7


8/15


Name, dose, route,

frequency


and Why ordered for

this patient


V.S. or lab values



patient


need to do

Oxytocin (Pitocin)

__2-10____ milliunits/

minute

IV (to induce or augmentlabor)

*Oxytocic

*Synthetic hormone that

stimulates uterine smooth

muscle to illicit stronger,longer, more frequent

uterine contractions. Has

vasoactive and

antidiuretic properties.

*Induction or

augmentation of labor at

or near term.

(Murray &McKinney,

366)

*Adverse reactions may

occur d/t hypersensitivity

or overdose.

*Hypertonic uterineactivity leading to fetal

bradycardia or

tachycardia, reduced fetal

heart rate variability and

late decelerations.

*Impaired uterine blood

flow leading to fetal

asphyxia.

*Uterine rupture, abrutio

placentae, rapid birth

causing maternal or fetaltrauma, maternal fluid

retention, hypotension,

tachycardia, cardiac

dysrhythmias,

subarachnoid

hemorrhaging.

(Murray &McKinney,

366)

*Assess fetal heart rate

for at least 20 minutes

prior to administration to

identify reassuring ornonreassuring patterns,

*Perform Leopolds

maneuvers and/or vaginal

examination to verify

cephalic fetal

presentation.

-If fetal presentation is

not cephalic, notify

physician and do not

administer.

*Observer for effectivelabor pattern after

administration.

-Contractions q2-3

minutes, lasting 40-90

seconds at an intensity of

50-80 mm Hg.

-Observe for uterine

hypertonicity:

contractions occurring

less than 2 minutes apart,

rest interval shorter than

30 seconds, lasting longer

than 90-120 seconds each.

*Monitor fetal heart rate

for nonreassuring patterns

such as tachycardia,

bradycardia, decreased

variability or late

decelerations.

*If uterine hypertonicity

or nonreassuring fetal

heart patterns are

*Induction or progression

of labor.

(Murray &McKinney,

366)

*Advise patient that

contractions will

mimic menstrual

cramps and willincrease intensity.

(Skidmore, 722)

*Discuss with pt the

reason for

administration, and the

expected results.

(Skidmore, 722)


8


9/15


Name, dose, route,

frequency


and Why ordered for

this patient


V.S. or lab values



patient


need to do

observed, d/c infusion,

increase rate of

nonadditive solution,

place mother on her sideand administer O2 mask

8-10 L/min; notify

physician.

(Murray

&McKinney,366)

Nalbuphine (Nubain)

5-10 mg IV q 3-4 hours

prn pain

*Opioid analgesic

*Inhibits ascending pain

pathways and alters pain

perception

*Analgesia/intrapartum

supplement for delivery

(Murray &McKinney,

344; Skidmore, 664)

*Respiratory depression,

rash, nausea, vomiting,

cramps, drowsiness,

dizziness, confusion,

H/A, sedation.(Skidmore, 664)

*Assess current

medications and hx-

contraindicated for

opiate-dependant pts and

may reverse analgesiceffects of some other

narcotics such as

meperidine.

(Murray &McKinney,

344)

*Assess pain before and

after administration.

*Monitor VS, especially

respiratory status.

*Monitor CNS changes-

LOC, dizziness,confusion, pupil reaction.

*Monitor for allergic

reaction such as rash and

uticaria.

(Skidmore, 664)

*Relief of pain and

pruritis r/t epidural

narcotics. (Murray

&McKinney, 344)

*Advise pt that

dizziness, drowsiness

and confusion are

common and they

should ask forassistance before

ambulating.

*Instruct pt to change

position slowly to

prevent orthostatic

hypotension.

*Discuss with the pt

reasons for

administering and the

expected results.

(Skidmore, 664)


9


10/15


Name, dose, route,

frequency


and Why ordered for

this patient


V.S. or lab values



patient


need to do

Fentanyl ___6___mcg.

via epidual

*Opioid analgesic

*Inhibits CNS ascending

pain pathways, increases

pain threshold; binds toopiate receptors to alter

pain perception.

*Relief of pain, adjuct to

epidural anesthesia.

(Skidmore, 401)

*Respiratory depression,

bradycardia, cardiac and

respiratory arrest,

laryngospasm, musclerigidity.

(Skidmore, 402)

*Monitor respiratory

status for 24 hours

*Assess VS

*Assess pain rating

regularly

*Assess ROM


reaction

*Monitor for CNS

changes-LOC, pupil

reaction, dizziness,

drowsiness.

(Murray &McKinney,

342-343; Skidmore, 402)

*Pt will have a reduction

in pain within 10

minutes.

(Murray &McKinney,342; Skidmore, 402)

*Advise pt that

dizziness, drowsiness

and confusion are

common and theyshould ask for

assistance before

ambulating.

*Instruct pt to change

position slowly to

prevent orthostatic

hypotension.

*Discuss with the pt

reasons for

administering and the

expected results.

(Skidmore, 403)

3Ephedrine sulfate 25-50

mg IV push for

hypotension due to spinal

or epidural anesthesia

*Vasopressor,

bronchodilator, nasal

decongestant

*Acts on beta receptors

in heart to increase

contractility and HR, acts

on alpha-receptors in

blood vessels to cause

vasoconstriction.

(Skidmore, 365)*Correction of

hypotension r/t epidural

or subarachnoid block

(Murray & McKinney,

344)

*Tremors, anxiety,

anorexia, nausea,

vomiting

(Skidmore, 357)

*Monitor BP and pulse

q5min when

administering IV


function r/t

bronchodilator action


reaction and paradoxical

brochospasm

*Assess for paresthesiasand coldness or

extremities r/t reduced

peripheral blood flow

(Skidmore, 357)

*Increased B/P

(Skidmore, 357)

*Explain reason for

medication and

expected outcome.

Oxytocin (Pitocin)

___2___Units added to 1st

postpartum IV (to prevent

pp hemorrhage)

*Oxytocic

*Synthetic hormone that

stimulates uterine smooth

muscle to illicit stronger,

longer, more frequent

*Adverse reactions may

occur d/t hypersensitivity

or overdose.

*Uterine hypertonicity

*Hypotension,

*Monitor VS q15 mins or

follow postpartum agency

protocol.

*Monitor lochia color,

quantity and presence of

clots.

*No incidence of uterine

pp hemorrhage (Murray

& McKinney, 366)

*Explain reason for

administration and

expected outcome.

(Skidmore, 722)


10


11/15


Name, dose, route,

frequency


and Why ordered for

this patient


V.S. or lab values



patient


need to do

uterine contractions. Has

vasoactive and

antidiuretic properties.

*Maintance of uterinecontractility post partum

to control bleeding.

(Murray &McKinney,

366)

tachycardia, cardia

dysrhythmias,

subarachnoid

hemorrhage.(Murray & McKinney,

366)

-notify physician for

bright red lochia or large

clots

*Observe uterus forfirmness, height, and

deviation.

*Palpate uterus, and

massage until firm if it is

boggy.

*Monitor I&O and

auscultate breath sounds

to identify fluid retention.

*Assess for cramping.

(Murray & McKinney,

366)

Methylergonovine maleate

(Methergine) 0.2 mg

po/IM/IV q 2-5 hours

*Oxytocic

*Stimulates continuous

uterine contraction and

causes arterial

vasoconstriction.

*Prevention and tx of pp

hemorrhage r/t uterine

atony or subinvolution.

(Murray & McKinney,

733)

*Nausea, vomiting,

uterine cramping,

hypertension, dizziness,

H/A, dyspnea, chest pain

& palpitations, peripheral

ischema, uterine and GI

cramping.

(Murray & McKinney,

733)

*Assess B/P prior to

administration and

monitor per agency

protocol.

*Assess fundal tone;

check for nonphasic

contractions, relaxation or

severe cramping.

(Murray & McKinney,

733; Skidmore, 615)

*Uterine contraction and

involution.

*Progression of

involution.

(Murray & McKinney,

733)

*Discuss reason for

administration and

expected outcome.

*Advise pt not to

smoke d/t increased

vasoconstriction

(Murray & McKinney,

733)

Terbutaline sulfate

0.25 mg subcutaneously

(discuss off-label use as a

tocolytic, not as an asthma

medication)

*Selective Beta-agonist

*Stimulates beta-

adrenergic receptors in

sympathetic nervous

system which inhibits

uterine muscular activity

*Stop preterm labor and

reduce or stop hypertonic

uterine contractions.

(Murray & McKinney,

*Maternal and fetal

tachycardia, palpitations,

cardiac dysrhythmias,

chest pain, wide pulse

pressure

*Dyspnea, chest

discomfort

*Tremors, restlessness,

H/A, dizziness, weakness

*Hypokalemia,

*ECG, blood glucose and

electrolyte levels, and

urinalysis prior to

administration.

*Assess fetal heart rate

when drug is initiated and

at agency recommended

intervals.

*Assess maternal pulse,

B/P and respirations same

*Preterm labor is stopped

*Hypertonic uterine

contractions stopped

(Murray & McKinney,

713)

*Encourage pt to

empty bladder q 2hrs.

*S/S of preterm labor

to be aware of after

discharge

(Murray & McKinney,

713)


11


12/15


Name, dose, route,

frequency


and Why ordered for

this patient


V.S. or lab values



patient


need to do

713; Skidmore hyperglycemia

*Nausea, vomiting,

reduced bowel motility

*Flushing, diaphoresis

(Murray & McKinney,

713)

interval as FHR

monitoring.

*Notify physician for side

effects: maternal HR>120 bpm, respirations

>24, dyspnea, pulmonary

edema, systolic BP< 80-

90 mm Hg, FHR >160.

*Report continued uterine

activity

*Encourage pt to empty

bladder q 2hrs

(Murray & McKinney,

713)

Carboprost tromethamine

(Hemabate)

100-250-mcg q 1.5-3.5

hours IM (abortifacient)

250 mcg q 15-30 minutes

IM (pp hemorrhage)

*Oxytocic, abortifacient

*Stimulates uterine

contractions

*Loss or fetus; decreased

pp bleeding

(Skidmore, 176)

*Fever, chills, nausea,

vomiting, diarrhea

(Skidmore, 176)

*Monitor B/P and pulse;

monitor for changes

indicative of hemorrhage.


status

*Notify physician for

contractions lasting

>1minute

*Assess for incomplete

abortion

(Skidmore, 177)

*Abortion of fetus within

approximately 16 hours.

*No incidence of pp

hemorrhage

(Skidmore, 176)

*Advise pt to report

abdominal cramps,

increased temp or

blood loss or foul-

smelling lochia.

(Skidmore, 176)


12


13/15


Name, dose, route,

frequency


and Why ordered for

this patient


V.S. or lab values



patient


need to do


13


14/15

Medications -Newborn

Name, dose, route,

frequency


and Why ordered for

this infant


needed before

administering



infant

Parent teaching you

need to do

Vitamin K

(Aquamephyton) 1 mg.

IM x1 within 1 hour ofbirth

*Fat soluble vitamin

*Promotes formation of

clotting factors

II(prothrombin), VII, IX,

X by the liver

*Provides vitamin K to

neonate who can not

synthesize it in the

intestines d/t absence of

intestinal flora;

prevention of

hemorrhagic disease of

the newborn.


*Erythema, pain, edema

at site of injection

*Anaphylaxis, hemolysis,

hyperbilirubinemia

especially in preterm

infant or overdose

(Murray & McKinney,

501)

*May be delayed 1 hour

after birth to allow for

feeding and bonding

*Observe continuously

for any bruising or

bleeding

*Assess gestational age

for dosing

*Infant should be bathed

prior to administration

(Murray & McKinney,

501; Skidmore, 764)

*No incidence of

newborn hemorrhagic

disease.

(Murray & McKinney,

501)

*Educate parents

reason for

administration.(Murray & McKinney,

500)

Erythromycin eye

ointment to both eyes x1

within 1 hour of birth

*Antibiotic

*Inhibits protein

synthesis in bacteria

*Prophylaxis of

opthalmia neonatorum r/t

Neisseria gonorrhoeae

and Chlamydia

trachomatis **required

by law

(Murray & McKinney,

501)

*Burning, itching,

chemical conjunctivitis

lasting 24-48 hours.

(Murray & McKinney,

501)

*Cleanse eyes before

application

*Hold tube horizontally

when applying to avoid

injury

*Administer from inner

canthus to outer canthus

*Ointment may be wiped

from outer eye after 1

minute

(Murray & McKinney,

501)

*Prevention of opthalmia

neonatorum r/t Neisseria

gonorrhoeae and

Chlamydia trachomatis

*Educate parents

reason for

administration.

(Murray & McKinney,

500)

Hepatitis B vaccine

(Engerix-B)

10mcg/0.5 mL IM x1

*Vaccine

*Immunization against

hepatitis B infection

*prevention of Hep B in

exposed and unexposed

infants (Murray &

McKinney, 520)

*Pain or redness at

injection site

*Low-grade fever

(Murray & McKinney,

520)

*Obtain parental consent

*Bathe infant prior to

injections to prevent

contamination from

maternal blood

(Murray & McKinney,

520)

*Pt will not become

infected with Hepatitis B

(Murray & McKinney,

520)

*Parent teaching that

this vaccine will

prevent hep B

infection and infant

will need to receive a

series of 3 doses

(Murray & McKinney,


14


15/15

Medications -Newborn

Name, dose, route,

frequency


and Why ordered for

this infant


needed before

administering



infant

Parent teaching you

need to do

520)

Hepatitis B ImmuneGlobulin (HBIG)

0.5 mL within _____

hours of birth

*Immune globulin

*Provides antibodies and

passive immunity to

hepatitis B

*Prophylaxis for infants

of hepatitis B surface

antigen-positive mothers

(Murray & McKinney,

521)

*Pain and tenderness atinjections site

*Uticaria, anaphylactic

reaction

(Murray & McKinney,

521)

*Maternal hepatitis Bantigen screening

*Bathe infant prior to

injections to prevent

contamination from

maternal blood

(Murray & McKinney,

521)

*Prevention of hepatitisB infection

(Murray & McKinney,

521)

*Parent teaching aboutreason for medication

and expected outcome.

(Murray & McKinney,

521)


15

Documents

Nurs-134 Medication Research Fa2010