Pharma Ob and Nutrition

7/25/2019 Pharma Ob and Nutrition

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Oxytocin Dosage and Administration

Parenteral drug products should be inspected visually for particulate matter and

discoloration prior to administration, whenever solution and container permit.

Dosage of Oxytocin is determined by the uterine response. The following dosage

information is based upon various regimens and indications in general use.

A. Induction or Stimulation of Labor

Intravenous infusion (drip method) is the only acceptable method of administration for

the induction or stimulation of labor.

Accurate control of the rate of infusion flow is essential. An infusion pump or other suchdevice and frequent monitoring of strength of contractions and fetal heart rate are

necessary for the safe administration of Oxytocin for the induction or stimulation of

labor. If uterine contractions become too powerful, the infusion can be abruptly stopped,

and oxytocic stimulation of the uterine musculature will soon wane.

1. An intravenous infusion of nonOxytocin-containing solution should be started.

Physiologic electrolyte solution should be used except under unusual circumstances.

2. To prepare the usual solution for infusion, 1-mL Oxytocin Injection, 10 USP Units/mL

is combined aseptically with 1,000 mL of nonhydrating diluent (physiologic electrolytesolution). The combined solution, rotated in the infusion bottle to ensure thorough

mixing, containing 10 mU/mL. Add the container with dilute oxytocic solution to the

system through use of a constant infusion pump or other such device, to control

accurately the rate of infusion.

3. The initial dose should be no more than 1 to 2 mU/min. the dose may be gradually

increased in increments of no more than 1 to 2 mU/min. until a contraction pattern has

been established which is similar to normal labor.

4. The fetal heart rate, resting uterine tone, and the frequency, duration, and the force of

contractions should be monitored.5. The Oxytocin infusion should be discontinued immediately in the event of uterine

hyperactivity or fetal distress. Oxygen should be administered to the mother. The mother

and the fetus must be evaluated by the responsible physician.

B. Control of Postpartum Uterine Bleeding


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1. Intravenous Infusion (Drip Method):

To control postpartum bleeding, 10 to 40 units of Oxytocin may be added to 1,000 mL of

a nonhydrating diluent (physiologic electrolyte solution) and run a rate necessary to

control uterine atony.2. Intramuscular Administration:

1 mL (10 units) of Oxytocin can be given after the delivery of the placenta.

C. Treatment of Incomplete or Inevitable Abortion

Intravenous infusion with physiologic saline solution, 500 mL, or 5% dextrose in

physiologic saline solution to which 10 units of Oxytocin have been added should be

infused at a rate of 20 to 40 drops per minutes.

Generic Name: Methergine

Brand name:Methylergonovine Maleate

Pharmacologic:ergot alkaloids

Availability Tablets:200 mcg (0.2 mg).Injection:200 mcg (0.2 mg)/ml in 1-ml

ampules.

Action

Methylergonovine maleate(methergine) is an ergot alkaloid that stimulate smooth

muscle tissue.Because the smooth muscle of the uterus is especially sensitive to this

drug it is used postpartally to stimulate the uterus to contract in order to decrease

!lood loss !y clamping off uterine !lood vessels and to promote the involution

process ."n addition the drug has vasoconstrictive effect on all !lood vesselsespecially

the larger arteries.

Route,osage,!re"uency

Methergine has a rapid onset of action and may !e given orally or intramuscularly.

#sually IM dose: #$% mgfollo$ing e%pulsion of the placenta.&he dose may !erepeated every 2-' hours if necessary.

#sual oral dose: #$% mgevery ' hours (si% doses)

Maternal &ontraindications

regnancyhepatic or renal disease cardiac disease hypertension or preeclampsia


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contraindicate this drugs use.Methylergonovine maleate must !e used $ith caution

during lactation.

Maternal 'ide ())ects

ypertensionnauseavomitingheadache!randycardiadi**inesstinnitusa!dominal

crampspalpitationsdyspneachest pain and allergic reactions may !e noted.

Nursing Im*lications

Monitor fundal height and consistency and the amount and character of the

lochia.

+ssess the !lood pressure !efore and routinely throughout drug

administration.

,!serve for adverse effects or symptoms of ergot to%icity(ergotism) such as

nausea and vomitingheadachemuscle paincold or num! fingers and

toeschest pain and general $eakness.

Patient +!amily Teaching

"nstruct patient to take medication as directed do not skip or dou!le up on

missed doses. "f a dose is missed omit it and return to regular dose schedule.

+dvise patient that medication may cause menstrual-like cramps

aution patient to avoid smoking !ecause nicotine constricts !lood vessels.

"nstruct patient to notify health care professional if infection develops as this

may cause increased sensitivity to the medication.

Nursing ImplicationsAssessment & Drug Effects

Monitor vital signs (particularly BP) and uterine response during and afterparenteral administration of methylergonovine until partum period is

stabilized (about 12 h).

otify physician if BP suddenly increases or if there are fre!uent periods ofuterine rela"ation.

Patient & Family Education

#eport severe cramping for increased bleeding.


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#eport any of the follo$ing% &old or numb 'ngers or toes nausea or vomitingchest or muscle pain.

o not breast feed $hile ta*ing this drug.

Magnesium +ulfate rug +tudy

&lassi'cation% ,herapeutic% mineral and electrolyte

replacements-supplements. Pharmacologic% minerals-electrolytes

ndications

,reatment-prevention of hypomagnesemia. ,reatment of hypertension.

/nticonvulsant associated $ith severe eclampsia pre0eclampsia or acute nephritis.

nlabeled uses% Preterm labor. ,reatment of ,orsade de pointes. /dunctive

treatment for bronchodilation in moderate to severe acute asthma.

Mechanism of /ction3ssential for the activity of many enzymes. Plays an important role in

neurotransmission and muscular e"citability. ,herapeutic 34ects% #eplacement in

de'ciency states. #esolution of eclampsia.

&ontraindications-Precautions

&ontraindicated in%5ypermagnesemia6 5ypocalcemia6 /nuria6 5eart bloc*6 /ctive

labor or $ithin 2 hr of delivery (unless used for preterm labor). se &autiously

in% /ny degree of renal insu7ciency6 igitalized patients.

/dverse #eactions-+ide 34ects
http://nursecareplan.blogspot.com/2012/04/magnesium-sulfate-drug-study_2796.htmlhttp://nursecareplan.blogspot.com/2012/04/magnesium-sulfate-drug-study_2796.html


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&+% dro$siness. #esp% decreased respiratory rate. &8% arrhythmias bradycardia

hypotension. 9% diarrhea.M+%muscle $ea*ness. erm% :ushing s$eating.

Metab% hypothermia.

#oute-osage

,reatment of e'ciency (e"pressed asmg of Magnesium)M 8 (/dults)% +evere de'ciency;


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iron supplement (Oral route,

Parenteral route)Uses For iron supplement

Iron is a mineral that the body needs to produce red blood cells. When the body does

not get enough iron, it cannot produce the number of normal red blood cells needed to

keep you in good health. This condition is called iron deficiency (iron shortage) or iron

deficiency anemia.

Although many people in the U.S. get enough iron from their diet, some must take

additional amounts to meet their needs. For example, iron is sometimes lost with slow or

small amounts of bleeding in the body that you would not be aware of and which can

only be detected by your doctor. Your doctor can determine if you have an iron

deficiency, what is causing the deficiency, and if an iron supplement is necessary.

Lack of iron may lead to unusual tiredness, shortness of breath, a decrease in physical

performance, and learning problems in children and adults, and may increase your

chance of getting an infection.

Some conditions may increase your need for iron. These include:

Bleeding problems

Burns

Hemodialysis

Intestinal diseases

Stomach problems

Stomach removal

Use of medicines to increase your red blood cell count

In addition, infants, especially those receiving breast milk or low-iron formulas, may

need additional iron.


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Increased need for iron supplements should be determined by your health care

professional.

Injectable iron is administered only by or under the supervision of your health care

professional. Other forms of iron are available without a prescription; however, yourhealth care professional may have special instructions on the proper use and dose for

your condition.

Importance of Diet

For good health, it is important that you eat a balanced and varied diet. Follow carefully

any diet program your health care professional may recommend. For your specific

dietary vitamin and/or mineral needs, ask your health care professional for a list of

appropriate foods. If you think that you are not getting enough vitamins and/or mineralsin your diet, you may choose to take a dietary supplement.

Iron is found in the diet in two formsheme iron, which is well absorbed, and nonheme

iron, which is poorly absorbed. The best dietary source of absorbable (heme) iron is

lean red meat. Chicken, turkey, and fish are also sources of iron, but they contain less

than red meat. Cereals, beans, and some vegetables contain poorly absorbed

(nonheme) iron. Foods rich in vitamin C (e.g., citrus fruits and fresh vegetables), eaten

with small amounts of heme iron-containing foods, such as meat, may increase the

amount of nonheme iron absorbed from cereals, beans, and other vegetables. Somefoods (e.g., milk, eggs, spinach, fiber-containing, coffee, tea) may decrease the amount

of nonheme iron absorbed from foods. Additional iron may be added to food from

cooking in iron pots.

The daily amount of iron needed is defined in several different ways.

For U.S.

Recommended Dietary Allowances (RDAs) are the amount of vitamins and minerals

needed to provide for adequate nutrition in most healthy persons. RDAs for a given nutrientmay vary depending on a person's age, sex, and physical condition (e.g., pregnancy).

Daily Values (DVs) are used on food and dietary supplement labels to indicate the

percent of the recommended daily amount of each nutrient that a serving provides. DV

replaces the previous designation of United States Recommended Daily Allowances

(USRDAs).


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For Canada

Recommended Nutrient Intakes (RNIs) are used to determine the amounts of vitamins,

minerals, and protein needed to provide adequate nutrition and lessen the risk of chronic

disease.

Normal daily recommended intakes in milligrams (mg) for iron are generally defined as

follows (Note that the RDA and RNI are expressed as an actual amount of iron, which is

referred to as elemental' iron. The product form [e.g., ferrous fumarate, ferrous

gluconate, ferrous sulfate] has a different strength):

Persons U.S.

(mg)

Canada

(mg)

Infants birth to 3 years of age 610 0.36

Children 4 to 6 years of age 10 8

Children 7 to 10 years of age 10 810

Adolescent and adult males 10 810

Adolescent and adult females 1015 813

Pregnant females 30 1722

Breast-feeding females 15 813

Before Using iron supplement

If you are taking a dietary supplement without a prescription, carefully read and follow

any precautions on the label. For these supplements, the following should be

considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this

group or any other medicines. Also tell your health care professional if you have any

other types of allergies, such as to foods dyes, preservatives, or animals. For non-

prescription products, read the label or package ingredients carefully.


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Pediatric

Problems in children have not been reported with intake of normal daily recommended

amounts. Iron supplements, when prescribed by your health care professional, are not

expected to cause different side effects in children than they do in adults. However, it isimportant to follow the directions carefully, since iron overdose in children is especially

dangerous.

Studies on sodium ferric gluconate have shown that this supplement is safe to use in

children ages 6 to 15 years. The safety of sodium ferric gluconate has not been

determined in patients who are younger than 6 years of age.

Geriatric

Problems in older adults have not been reported with intake of normal daily

recommended amounts. Elderly people sometimes do not absorb iron as easily as

younger adults and may need a larger dose. If you think you need to take an iron

supplement, check with your health care professional first. Only your health care

professional can decide if you need an iron supplement and how much you should take.

Pregnancy

It is especially important that you are receiving enough vitamins and minerals when you

become pregnant and that you continue to receive the right amount of vitamins and

minerals throughout your pregnancy. Healthy fetal growth and development depend on a

steady supply of nutrients from mother to fetus. During the first 3 months of pregnancy,

a proper diet usually provides enough iron. However, during the last 6 months, in order

to meet the increased needs of the developing baby, an iron supplement may be

recommended by your health care professional.

However, taking large amounts of a dietary supplement in pregnancy may be harmful to

the mother and/or fetus and should be avoided.

Breast Feeding

It is especially important that you receive the right amounts of vitamins and minerals so

that your baby will also get the vitamins and minerals needed to grow properly. Iron

normally is present in breast milk in small amounts. When prescribed by a health care


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professional, iron preparations are not known to cause problems during breast-feeding.

However, nursing mothers are advised to check with their health care professional

before taking iron supplements or any other medication. Taking large amounts of a

dietary supplement while breast-feeding may be harmful to the mother and/or infant and

should be avoided.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two

different medicines may be used together even if an interaction might occur. In these

cases, your doctor may want to change the dose, or other precautions may be

necessary. When you are taking any of these dietary supplements, it is especially

important that your healthcare professional know if you are taking any of the medicines

listed below. The following interactions have been selected on the basis of their potentialsignificance and are not necessarily all-inclusive.

Using dietary supplements in this class with any of the following medicines is usually not

recommended, but may be required in some cases. If both medicines are prescribed

together, your doctor may change the dose or how often you use one or both of the

medicines.

Altretamine

Amygdalin

Dabrafenib

Dasabuvir

Deferoxamine

Digoxin

Eltrombopag

Elvitegravir

Ketoconazole

Ledipasvir

Paritaprevir

Pazopanib


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Phenytoin

Rilpivirine

Vismodegib

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating

certain types of food since interactions may occur. Using alcohol or tobacco with certain

medicines may also cause interactions to occur. Discuss with your healthcare

professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of dietary supplements in

this class. Make sure you tell your doctor if you have any other medical problems,

especially:

Alcohol abuse (or history of) or

Blood transfusions (with high red blood cell iron content) or

Kidney infection or

Liver disease or

Porphyria cutaneous tardaHigher blood levels of the iron supplement may occur, which

may increase the chance of side effects.

Arthritis (rheumatoid) or

Asthma or allergies or

Heart diseaseThe injected form of iron may make these conditions worse.

Colitis or other intestinal problems or

Iron overload conditions (e.g., hemochromatosis, hemosiderosis, hemoglobinopathies)or

Stomach ulcerIron supplements may make these conditions worse.

Other anemiasIron supplements may increase iron to toxic levels in anemias not

associated with iron deficiency.


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Proper Use of iron supplement

After you start using this dietary supplement, continue to return to your health care

professional to see if you are benefiting from the iron. Some blood tests may be

necessary for this.

Iron is best absorbed when taken on an empty stomach, with water or fruit juice (adults:

full glass or 8 ounces; children: glass or 4 ounces), about 1 hour before or 2 hours

after meals. However, to lessen the possibility of stomach upset, iron may be taken with

food or immediately after meals.

For safe and effective use of iron supplements:

Follow your health care professional's instructions if this dietary supplement was

prescribed.

Follow the manufacturer's package directions if you are treating yourself. If you think you

still need iron after taking it for 1 or 2 months, check with your health care professional.

Liquid forms of iron supplementtend to stain the teeth. To prevent, reduce, or remove

these stains:

Mix each dose in water, fruit juice, or tomato juice. You may use a drinking tube or straw

to help keep the iron supplement from getting on the teeth.

When doses of liquid iron supplement are to be given by dropper, the dose may be

placed well back on the tongue and followed with water or juice.

Iron stains on teeth can usually be removed by brushing with baking soda (sodium

bicarbonate) or medicinal peroxide (hydrogen peroxide 3%).

Dosing

The dose medicines in this class will be different for different patients. Follow your

doctor's orders or the directions on the label. The following information includes only the

average doses of these medicines. If your dose is different, do not change it unless your

doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also,

the number of doses you take each day, the time allowed between doses, and the length


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of time you take the medicine depend on the medical problem for which you are using

the medicine.

For oral dosage forms (capsules, tablets, oral solution):

o To prevent deficiency, the amount taken by mouth is based on normal daily

recommended intakes:

For the U.S.

o Adult and teenage males10 milligrams (mg) per day.

o Adult and teenage females10 to 15 mg per day.

o Pregnant females30 mg per day.

o Breast-feeding females15 mg per day.

o Children 7 to 10 years of age10 mg per day.


o Children birth to 3 years of age6 to 10 mg per day.

o For Canada

o Adult and teenage males8 to 10 mg per day.

o Adult and teenage females8 to 13 mg per day.

o Pregnant females17 to 22 mg per day.

o Breast-feeding females8 to 13 mg per day.

o Children 7 to 10 years of age8 to 10 mg per day.


o Children birth to 3 years of age0.3 to 6 mg per day.

2 To treat deficiency:

o Adults, teenagers, and children The dose will be determined by your

doctor, based on your condition.

2 For injection dosage forms:

1 Adults, teenagers, and children The dose will be determined by your doctor, based on

your condition.


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Missed Dose

If you miss a dose of iron supplement, skip the missed dose and go back to your regular

dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat,

moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using iron supplement

When iron is combined with certain foods it may lose much of its value. If you are taking

iron, the following foods should be avoided, or only taken in very small amounts, for at

least 1 hour before or 2 hours after you take iron:

Cheese and yogurt

Eggs

Milk

Spinach

Tea or coffee

Whole-grain breads and cereals and bran

Do not take iron supplements and antacids or calcium supplements at the same time. It

is best to space doses of these 2 products 1 to 2 hours apart, to get the full benefit from

each medicine or dietary supplement.

If you are taking iron supplementswithout a prescription:

Do not take iron supplements by mouth if you are receiving iron injections. To do so may

result in iron poisoning.


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Do not regularly take large amounts of iron for longer than 6 months without checking

with your health care professional. People differ in their need for iron, and those with certain

medical conditions can gradually become poisoned by taking too much iron over a period of

time. Also, unabsorbed iron can mask the presence of blood in the stool, which may delay

discovery of a serious condition.

If you have been taking a long-acting or coated iron tablet and your stools

havenotbecome black, check with your health care professional. The tablets may not

be breaking down properly in your stomach, and you may not be receiving enough iron.

It is important to keep iron preparations out of the reach of children. Keep a 1-ounce

bottle ofsyrupof ipecac available at home to be taken in case of an iron overdose

emergency when a doctor, poison control center, or emergency room orders its use.

If you think you or anyone else has taken an overdose of iron medicine:

Call your doctor, a poison control center, or the nearest hospital emergency room at

once. Always keep these phone numbers readily available.

Follow any instructions given to you. If syrup of ipecac has been ordered and given, do

not delay going to the emergency room while waiting for the ipecac syrup to empty the

stomach, since it may require 20 to 30 minutes to show results

Go to the emergency room without delay

Take the container of iron with you.

Early signs of iron overdose may not appear for up to 60 minutes or more. Do not delay

going to the emergency room while waiting for signs to appear.

iron supplement Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although

not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common-with injection only

Backache , groin, side, or muscle pain


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chest pain

chills

dizziness

fainting

fast heartbeat

fever with increased sweating

flushing

headache

metallic taste

nausea or vomiting

numbness, pain, or tingling of hands or feet

pain or redness at injection site

redness of skin

skin rash or hives

swelling of mouth or throat

troubled breathing

More common-when taken by mouth only

Abdominal or stomach pain

cramping (continuing) or soreness

Less common or rare-with injection only

Double vision

general unwell feeling

weakness without feeling dizzy or faint

Less common or rare-when taken by mouth only

Chest or throat pain, especially when swallowing

stools with signs of blood (red or black color)

Early symptoms of iron overdose


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Symptoms of iron overdose may not occur for up to 60 minutes or more after the

overdose was taken. By this time you should have had emergency room treatment. Do

not delay going to emergency room while waiting for signs to appear.

Diarrhea (may contain blood)

fever

nausea

stomach pain or cramping (sharp)

vomiting, severe (may contain blood)

Late symptoms of iron overdose

Bluish-colored lips, fingernails, and palms of hands

convulsions (seizures)

pale, clammy skin

shallow and rapid breathing

unusual tiredness or weakness

weak and fast heartbeat

Some side effects may occur that usually do not need medical attention. These side

effects may go away during treatment as your body adjusts to the medicine. Also, your

health care professional may be able to tell you about ways to prevent or reduce some

of these side effects. Check with your health care professional if any of the following

side effects continue or are bothersome or if you have any questions about them:

More common

Constipation

diarrhea

leg cramps

nausea

vomiting

Less common


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Stools commonly become dark green or black when iron preparations are taken by

mouth. This is caused by unabsorbed iron and is harmless. However, in rare cases,

black stools of a sticky consistency may occur along with other side effects such as red

streaks in the stool, cramping, soreness, or sharp pains in the stomach or abdominal

area. Check with your health care professional immediately if these side effects appear.

If you have been receiving injections of iron, you may notice a brown discoloration of

your skin. This color usually fades within several weeks or months.

Darkened urine

heartburn

stained teeth

Other side effects not listed may also occur in some patients. If you notice any other

effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the

FDA at 1-800-FDA-1088.

AdministrationOral

9ive on an empty stomach if possible because oral iron preparations are bestabsorbed then (i.e. bet$een meals). Minimize gastric distress if needed bygiving $ith or immediately after meals $ith ade!uate li!uid.

o not crush tablet or empty contents of capsule $hen administering.

o not give tablets or capsules $ithin 1 h of bedtime.

&onsult physician about prescribing a li!uid formulation or a less corrosiveform such as ferrous gluconate if the patient e"periences di7culty in

s$allo$ing tablet or capsule.

ilute li!uid preparations $ell and give through a stra$ or placed on the bac*of tongue $ith a dropper to prevent staining of teeth and to mas* taste.nstruct the patient to rinse mouth $ith clear $ater immediately afteringestion.


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Mi" ferosol eli"ir $ith $ater6 not compatible $ith mil* or fruit uice. Cer0n0+ol(drops) may be given in $ater or in fruit or vegetable uice according tomanufacturer.

o not use discolored tablets.

+tore in tightly closed containers and protect from moisture. +tore at 1?D@D& (?ED


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:. e;uest prescri!ed !lood/!lood components from !lood !ank to include !lood

typing and cross matching and !lood result of transmissi!le 5isease.

. ave a doctor and a nurse assess patients condition. ountercheck the

compati!le !lood to !e transfused against the crossmatching sheet noting the

+B, grouping and serial num!er of each !lood unit and e%piry date $ith

the !lood !ag la!el and other la!oratory !lood e%ams as re;uired !efore

transfusion.

7. 4et the !aseline vital signs- B and &emperature !efore transfusion.

efer to M5 accordingly.

10.4ive pre-meds 0 minutes !efore transfusion as prescri!ed.

11.5o hand hygiene !efore and after the procedure12.repare e;uipment needed for B& (" in?ection tray compati!le B& set "

catheter/ needle 4 17/17 plaster torni;uet !lood !lood components to !e

transfused lain 899 :00cc " set needle gauge 1> (only if needed) "

hook gloves sterile 2@2 gau*e or transplant dressing etc.

1."f main "f is $ith de%trose :A initiate an " line $ith appropriate " catheter

$ith lain 899 on another site anchor catheter properly and regulate "

drops.

1'.,pen compati!le !lood set aseptically and close the roller clamp. 9pike !lood

!ag carefully fill the drip cham!er at least half full prime tu!ing and remove

air !u!!les (if any). #se needle g.1> or 17 for side drip (for adults) or g.22 for

pedia (if !lood is given to the -in?ection port the gauge of the needle is

disregarded).

1:.5isinfect the -in?ection port of " tu!ing (lain 899) and insert the needle

from B& administration ser and secure $ith adhesive tape.

1


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open the " line $ith lain 899 and regulate accordingly and report to the

doctor immediately.

17.9$irl the !ag gently from time to time to mi% the solid $ith the plasma 8.B

one B.& set should !e used for 1-2 units of !lood.

20.=hen !lood is consumed close the roller clamp of B& and disconnect from "

lines then regulate the "D of plain 899 as prescri!ed.

21.ontinue to o!serve and monitor patient post transfusion for delayed reaction

could still occur.

22.e-check g! and ct !leeding time serial platelet count $ithin specified

hours as prescri!ed and/or per institutions policy.

2.5iscard !lood !ag and B& set and sharps according to ealth are =aste

Management (5,/538).

2'.Dill-out adverse reaction sheet as per institutional policy.2:.emind the doctor a!out the administration of alcium 4luconate if patient

has several units of !lood transfusion (-: more units of !lood).

Blood administration

Patient preparation

Pretransfusion check

Blood Transfusion Record

Transfusion Tag

Care and monitoring of transfused patients

BLOOD PRODUCT ADMII!TRATIO "PD#$poster

PLAT%L%T ADMII!TRATIO "PD#$Posters

ursing Competence

It is recommended that all nurses at RC& pro'iding care to children recei'ing (lood transfusions ha'e

completed the (lood transfusion competenc) package* +ou can access the package through )our

ursing Competence ,ork(ook*
http://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Patient_Preparationhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Pretransfusion_checkhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Blood_Transfusion_Recordhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Transfusion_Taghttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Care_and_monitoringhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/BLOOD_PRODUCT_ADMINISTRATION.pdfhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/PLATELET_ADMINISTRATION.pdfhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/PLATELET_ADMINISTRATION.pdfhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Patient_Preparationhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Pretransfusion_checkhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Blood_Transfusion_Recordhttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Transfusion_Taghttp://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/#Care_and_monitoringhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/BLOOD_PRODUCT_ADMINISTRATION.pdfhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/BLOOD_PRODUCT_ADMINISTRATION.pdfhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/PLATELET_ADMINISTRATION.pdfhttp://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/PLATELET_ADMINISTRATION.pdf


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Patient Preparation

The patient should (e read) for transfusion prior to picking up (lood from the (lood (ank* eg appropriate

I- access. ,ritten order for transfusion*

#or an) non/emergenc) transfusion the patient0parents should ha'e had the (enefits0risks of transfusion

discussed and an opportunit) to ha'e an) 1uestions ans,ered* Consent for transfusion should then (e

documeted in the medical record*

#or further information and for parent and patient information packs see2 Consent and Consumer

Information 3uideline

Pretransfusion check

+ae transusion re,uires a -nal patient identit. chec* at the patientedside eore lood administration' "his is vital to ensure the right lood

is given to the right patient'

The pretransfusion check must (e completed (efore commencing transfusion () t,o clinical staff. one of

,hom must then spike and connect the product* The staff mem(ers signing the (lood transfusion record

are indicating that the check has (een completed prior to transfusion. and that no discrepanc) ,as

identified*

The follo,ing checks are carried out at the (edside to ensure the right patient recei'es the right (lood

product2

4* Check (lood product for an) signs of leakage. clumps or a(normal colour*

5* Patient identification* Check name. DOB and UR on the Blood Transfusion Record and

pack tag0la(el* Check name. DOB 6 UR on the patient7s ,rist(and* Are the) identical8

9* Blood product identification* Check the pack num(er on the Blood Transfusion Record.

pack tag0la(el and the product* Are the) identical8

:* Blood 3roup* Check the (lood group "ABO and RhD$ of the product on the Blood

Transfusion Record "this form reports compati(ilit)$. pack tag0la(el and the product* Do the)

match8

;* Check e


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=* Check medical orders re product t)pe. special re1uirements "eg irradiation. leucoc)te

depletion$ and administration re1uirements "eg 'olume. rate$*

>* Complete documentation2 sign. date. time the Blood Transfusion Record and file in the

patient7s medical record*

IMP!"A#"

If there is an) discrepanc) (et,een the (lood product. patient details 6 pack tag0la(el or if )ou

are concerned a(out the appearance of the product D #" "!A#SF$SE* Report to Blood Bank

immediatel)2 RC& ?n ;@5. R& ?n 5;;*

Blood "ransfusion !ecord

A Blood Transfusion Record "MR054$ accompanies the release of fresh (lood products*


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"he /lood "ransusion 0ecord is a legal document and must e -led in the

patient medical record at the completion o transusion' "he record must

e availale or at least 2 .ears'

"ransfusion "ag

A tag is attached to each (lood product*

%are and monitoring of transfused patients

Patients receiving transfusion should be monitored for symptoms/signs of potential

complications of transfusion.

"he !o&al 'omen(s )ospital

#re1uenc) of 'ital signs2

Adults/ temperature. pulse. respirator) rate and (lood pressure should (e measured and recorded2


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(efore the start of each pack of (lood or (lood product

at 4; minutes after commencement

hourl) during transfusion

at the completion of each pack

#eonates/ temperature. heart rate and respirator) rate should (e measured and recorded2

(efore the start of each pack of (lood or (lood product

hourl) during transfusion

at the completion of each pack

ote that more fre1uent 'ital signs should (e taken if the patient has an unsta(le underl)ing condition or itthe patient (ecomes un,ell or sho,s signs of a transfusion reaction*

Patients should (e o(ser'ed during the first 4; minutes of transfusion as some life/threatening reactions

ma) occur after the infusion of onl) a small amount of (lood* here possi(le. patients should (e informed

of possi(le s)mptoms of a transfusion reaction and should inform staff immediatel) if the) feel un,ell

during transfusion*

!o&al %hildren(s )ospital

-ital signs "temperature. pulse. respirations. (lood pressure. o


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Preterm la(or is defined as uterine contractions occurring after 5 ,eeks of

gestation and (efore 9> completed ,eeks of gestation* Risk factors

include multiple gestation, history of previous preterm labor of

delivery, abdominal surgery during current pregnancy,

uterine anomaly, history of cone biopsy, maternal age younger than

20 or older than age 35.

CLIICAL MAI#%!TATIO!

1. Go$ bac* pain

2. +uprapubic pressure. 8aginal presure

>. #hythmic uterine contrations

?. &ervical dilation and e4acement

=. Possible rupture of membranes

J. 3"pulsion of the cervical mucus plug


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Prepare for possible ultrasonography amniocentesis

tocolytic drug therapy and steroid theraphy

/dminister tocolytic (contraction0inhibiting) medications

as prescribed. /ssess for side e4ects of tocolytic therapy (eg decreased

maternal blood pressure dyspnea chest pain and C5#

e"ceeding 1 Provide physical and emotional support. Provide ade!uate

hydration

? Provide client and family education

Documents

Pharma Ob and Nutrition