OB Medication Card

Magnesium Sulfate
✓Trade Name: Epsom salt, magnesium sulfate
✓Classification: Electrolyte; anticonvulsant, laxative, saline; antacid
✓Dose/Route/Frequency for population being served: (breastfeeding) 335-350 mg/day; (pregnancy) 320 mg/day; PO 200-400 mg in divided doses tid-qid; IM 1 g q6hrs x 4 doses; IV 5g (severe)
✓Action: Increases osmotic pressure, draws fluid into the colon and neutralizes HCl
✓Side Effects: •CNS-flaccid paralysis, hypothermia •CV-circulatory collapse •GI-nausea, vomiting, anorexia, cramps •RESP-respiratory depression/paralysis
✓Nursing Implications: •Assess I&O ratio to check for decrease in urinary output •Assess cause of constipation; lack of fluids, bulk or exercise •Assess cramping, rectal bleeding, nausea, vomiting; product should be d/c’d •Assess Mg toxicity: thirst, confusion, decrease in reflexes •Assess visual changes: blurring, halos, corneal and retinal damage
•Assess edema in feet, ankles, and legs •Assess prior product history; there are many product interactions
Erythromycin Ointment
✓Trade Name: Ilotycin
✓Classification: Anti-infective
✓Dosage/Route/Frequency for population being served: PO (Neonates): Ethylsuccinate— 20-50 mg/kg/day divided q 6-12 hr.
✓Action: Inhibits folic acid synthesis by preventing PABA use, which is necessary for bacterial growth
✓Side Effects: •CNS-headache •CV-hypertension, tachycardia, dysrythmias •EENT-burning, stinging •GI-bitter taste
✓Nursing Implications: •Monitor opthalmic exams and intraocular pressure readings •Monitor blood counts; renal/heptic function tests and serum electrolytes during long-term treatment •Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy
Duramorph
✓Generic Name: Morphine
✓Classification: Opioid analgesic
✓Dosage/Route/Frequency for population being served: 5-20 mg; Subcut/IM; q4hrs PRN
✓Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
✓Side Effects: CNS-confusion, sedation, seizure •CV-bradycardia, shock, cardiac arrest, tachycardia •GI-constipation •GU-urinary retention •HEMA-thrombocytopenia •RESP-resp depression, resp arrest, apenia
✓Nursing Implications: •Assess for pain •Monitor I&O ratio •Monitor CNS changes •Monitor allergic reactions •Assess resp dysfunction
Nubain
✓Generic Name: Nalbuphine
✓Classification: Opioid analgesic
✓Dosage/Route/Frequency for population being served:
•IM, SC, IV (Adults): Usual dose is 10 mg q 3-6 hr (single dose not to exceed 20 mg; total daily dose not to exceed 160 mg
✓Action: Inhibits ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus by binding to opiate receptor sites, thus altering pain perception and response
✓Side Effects: •CNS-drowsiness, dizziness, confusion, headache, sedation, euphoria •CV-cardiac arrest •GI-dry mouth, nausea, vomiting, anorexia, constipation, cramps •INTEG-rash, diaphoresis, clammy feeling •RESP-resp depression
✓Nursing Implications: •Assess pain characteristics before/after medication •Assess bowl status •Monitor VS after parenteral route •Monitor CNS changes •Monitor allergic reactions
Narcan
✓Generic Name: Naloxone HCl
✓Classification: Opioid antagonist, antidote
✓Dosage/Route/Frequency for population being served: •Opioid-induced resp depression-IV/Subcut/IM 0.4-2 mg; ; max 10 mg •Postop opioid-induced resp depression- IV 0.1-0.2 mg •Opioid overdose- IV/Subcut/IM 0.4 mg (10mcg/kg) (not opioid dependent); 0.1-0.2 mg (opioid dependent); Repeat q2-3min PRN
✓Action: Competes with opioids at opioid receptor sites
✓Side Effects:•CNS-seizures •CV-ventricular tachycardia, fibrillation, cardiac arrest, sinus tachycardia •GI-hepatotoxicity •RESP-pulmonary edema
✓Nursing Implications:•Assess for signs of opioid withdrawal in drug-dependent individuals: cramping, hypertension, anxiety, vomiting; may occur up to 2hrs after administration •Monitor VS q3-5 min, ABGs including Po2, PCo2 •Assess cardiac status •Assess for pain •Assess for resp dysfunction
Triple Antibiotic Ointment
✓Generic Name: Neomycin, Bacitracin
✓Classification: Antiinfective
✓Dosage/Route/Frequency for population being served: an amount equal to the surface area to the tip of your finger; Topical; 1-3 times daily
✓Action: Interferes with bacterial protein synthesis
✓Side Effects: rash, urticaria, scaling, redness
✓Nursing Implications: •Assess for allergic reactions: burning, stinging, swelling, redness •Assess for signs of nephrotoxicity and hepatotoxicity
Vitamin K
✓Generic Name: Phytonadione
✓Classification: Vitamin K, fat-soluble vitamin
✓Dosage/Route/Frequency for population being served:•Hypoprothrombinemia caused by vitamin K malabsorption- PO/IM 2.5-25 mg; may repeat or increase to 50 mg •Prevention of hemorrhagic disease of the newborn- neonates- 0.5-1 mg within 1hr after birth; repeat in 2-3wks if required
✓Action: Needed for adequate blood clotting (factors II, VII, IX, X) • Prevention of hemorrhagic disease of the newborn
✓Side Effects: •CNS-brain damage
•HEMA-hemolytic anemia, hemoglobulinuria, hyperbilirubinemia •RESP-bronchospasm, resp arrest
✓Nursing Implications:•Monitor protime during treatment; 2 sec deviation from control time, bleeding time, and clotting time •Monitor for bleeding, I&R pulse, blood pressure
•Assess nutritional status: liver (beef, spinach, tomatoes, coffee, asparagus, brocolli, cabbage, lettuce, greens) •Assess for bleeding or bruising: hematuria, black tarry stools, hematemesis
Methergine
✓Generic Name:Mehtylergonovine
✓Classification: Oxytocic
✓Dosage/Route/Frequency for population being served:•PO 200 mcg tid-qid up to 7 days •IM/IV 200 mcg q2-4hr for 1-5 doses
✓Action: Stimulates uterine and vascular smooth muscle, causing contractions, decreased bleeding, arterial vasoconstriction
✓Side Effects:•CNS-headache, dizziness, seizures
•CV:hypotension, hypertension, dysrythmias; CVA (IV) •GI-nausea, vomiting •RESP-dyspnea
✓Nursing Implications:
•Monitor b/p, pulse; watch for change that may indicate hemmorhage; check resp rate, rhythm, depth •Assess fundal tone, nonphasic contractions; check for relaxation or severe cramping •Assess for ergotism or overdose: nausea, vomiting, weakness, muscular pain, insensitivity to cold, paresthesia of extremities •Check Ca levels before administering; if hypocalcemia is present, correction should be made to increase effectiveness of this product •Monitor prolactin levels and for decreased milk production
Betamethasone
✓Trade Name: Betacort, Alphatrex, Bebn, Betatrex, Beta-Val, Betnovate, Celestoderm, Diprosone, Ectosonel, Luxiq, Maxivate, Metaderm, Psorion, Valosone
✓Classification: Topical glucorticoid
✓Dosage/Route/Frequency for population being served: •Adult and child-apply to affected area; topical; continue treatment for a few days after area has cleared
✓Action: Antipruritic, antiinflammatory
✓Side Effects: INTEG- acne, atrophy, epidermal thinning, purpura, striae
✓Nursing Implications:•Monitor temp; if fever develops, product should be discontinued •Monitor for systemic absorption, increased temp, inflammation, irritation
T dap
✓Generic/Trade Name: Diptheria, Tetanus, Pertussis Vaccine
✓Classification: Vaccinations
✓Dose/Route/Frequency for population being served:
•This booster immunization is given at age 11 for continued protection
•0.5 mL IM to replace one dose of DTaP
✓Action: Protects from tetanus, diptheria, and pertussis (whooping cough) •Single dose should be given instead of Td in adults (19-64 yr) if they received their last dose of Td B10 yr ago (and did not previously receive a dose of Tdap).
✓Side Effects: •Fatigue, headache, GI symptoms, pain at injection site
✓Nursing Implications:•Previous reactions to DTaP; progressive neurological disease; recent (within 7 days) CNS pathology.
MMR
✓Generic/Trade Name: Measles, Mumps, & Rubella Vaccine
✓Classification: Vaccination
✓Dosage/Route/Frequency for population being served: •0.5 mL subcut, 1 or 2 doses in adults born in 1957 or later with unreliable history •high-risk groups should receive a total of 2 doses given 1 mo apart
✓Action: Prevention for children and adults from all three diseases
✓Side Effects:♒Mild problems: •Fever •Mild rash •Swelling of the glands in cheeks or neck ♒Moderate problems- •seizures caused by fever •temporary pain and stiffness in joints •temporary low platelet count which can cause a bleeding disorder ♒Severe problems: •serious allergic reaction •defness •long-term seizures •coma •lowered consciousness
H-BIG
✓Generic/Trade Name: Hepatitis B immune globulin
✓Classification: Immune globulin
✓Dosage/Route/Frequency for population being served: •Adult and child: IM 0.06 mL/kg (usual 3-5 mL) within 7 days of exposure; repeat 28 days after exposure, if pt wishes not to receive the Hep B vaccine •Neonates born to Hep B surface antigen-positive persons: IM 0.5 mL within 12hrs of birth
✓Action: Provides passive immunity to Hepatitis B
✓Side Effects:•CNS-headache, dizziness, fever •GI-nausea, vomiting •INTEG-soreness at injection site, uticaria, erythema swelling •SYST-induration, anaphylaxis, angioedema
✓Nursing Implications: •Assess for history of allergies, skin conditions (eczema, psoriasis, dermaitis), reactions to vaccines •Assess for skin reactions: rash, induration, uticaria •Assess for sneezing, pertussis, angioedema, dysphasia, vomiting, abdominal pain •Assess for anaphylaxis: inability to breathe, bronchospasms, hypotension, wheezing, diaphoresis, fever, flushing; epinephrine and emergency equipment should be available
Acetaminophen
✓Trade Name: Tylenol
✓Classification: Nonopioid analgesic
✓Dosage/Route/Frequency for population being served: •Adult and child under 12 years: PO/Rect 325-650 mg q4-6hrs PRN, max 4 g/daily •Neonates: Rect 10-15 mg/kg/dose q6-8hrs
✓Action: May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess antiinflammatory properties; antipyuretic action results from inhibition of prostaglandins in the CNS
✓Side Effects: •GI-hepatotoxicity, hepatic seizure (overdose), GI bleeding •GU-renal failure •HEMA-leukopenia, neutropenia, hemolytic anemia (long-term use), thrombocytopenia, pancytopenia •SYST-hypersensitivity •Toxicity-cyanosis, anemia, neutropenia, jaundice, pancytopenia, CNS stimulation, delirium followed by vascular collapse, seizures, coma, death
✓Nursing Implications: •Monitor liver, renal, and blood function studies •Check I&O ratio •Assess for fever and pain •Assess for chronic poisoning •Assess for hepatotoxicity •Assess for allergic reactions
Hep B vaccine
✓Generic/Trade Name: Hepatitis B Vaccine
✓Classification: Vaccination
✓Dosage/Route/Frequency for population being served: •0.5 mL IM at 0, 1-2, and 6-18 mo. Dose is same for patients age 0-19 yr. •Infants born to HBsAg-positive mothers: Administer 0.5 mL of hepatitis B immune globulin IM and 1st dose of hepatitis B vaccine; give 2nd and 3rd doses of hepatitis B vaccine at 1 mo and 6 mo, respectively.
✓Action: Prevention of development of Hepatitis B
✓Side Effects: Local soreness
Influenza vaccine
✓Trade Name: Flu Vaccine
✓Classification: Vaccination
✓Dosage/Route/Frequency: •Injection: 0.5 mL IM annually. Intranasal (for adults <50 yr): Single 0.2 mL dose (given as 0.1 mL in each nostril) annually.
✓Action: Prevention of influenza
✓Side Effects: •Injection-local soreness, fever myalgia, possible neurologic toxicity •Intranasal-upper respiratory congestion, malaise •Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission with intranasal route.
✓Nursing Implications:(Considerations) •Hypersensitivity to eggs/egg products. Hypersensitivity to thimerosal (injection only). Patients with acute neurologic compromise. FluMist should be avoided in pregnancy; chronic pulmonary (including asthma), cardiovascular (not hypertension), renal, hepatic, neurological, hematologic, or metabolic (including diabetes) disorders; immunosuppression (including HIV); age B50 yr.
Simethicon / Mylicon
✓Trade Name: Gas X
✓Classification: Antiflatulent
✓Dosage/Route/Frequency: 40-125 mg qid, after meals and at bedtime (up to 500 mg/day)
✓Action: Causes the coalescence of gas bubbles; Passage of gas through the GI tract by belching or passing flatus
✓Side Effects: None Significant
✓Nursing Implications:(Considerations) PO: Administer after meals and at bedtime for best results. Shake liquid preparations well prior to administration. Chewable tablets should be chewed thoroughly before swallowing for faster and more complete results.
Drops can be mixed with 30 mL of cool water, infant formula, or other liquid as directed. Shake well before using.
Oxytocin
✓Trade Name: Pitocin
✓Classification: Oxytocics/hormones
✓Dosage/Route/Frequency: IV: (Adults) 0.5-1 milliunits/min; ↑ by 1-2 milliunits/min q 30-60 min until desired contraction pattern established; dose may be ↓ after desired frequency of contractions is reached and labor has progressed to 5-6 cm dilation. (Postpartum Hemorrage): IV: (Adults) 10 units infused at 20-40 milliunits/min.
IM: (Adults) 10 units after delivery of placenta.
✓Action: Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor; Induction of labor.
Control of postpartum bleeding.
✓Side Effects: CNS: (materna)l: COMA, SEIZURESfetal: INTRACRANIAL HEMORRHAGE
Resp: (feta)l: ASPHYXIA, hypoxia
CV: maternal: hypotensionfetal: arrhythmias
F and E: maternal: hypochloremia, hyponatremia, water intoxication
Misc: maternal: ↑ uterine motility, painful contractions, abruptio placentae, ↓ uterine blood flow, hypersensitivity
✓Nursing Implications:(Considerations) Fetal maturity, presentation, and pelvic adequacy should be assessed prior to administration of oxytocin for induction of labor.
– Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequently throughout administration. If contractions occur <2 min apart and are >50-65 mm Hg on monitor, if they last 60-90 sec or longer, or if a significant change in fetal heart rate develops, stop infusion and turn patient on her left side to prevent fetal anoxia. Notify health care professional immediately. Monitor maternal BP and pulse frequently and fetal heart rate continuously.
Calcium Gluconate
✓Trade Name: Kalcinate
✓Classification: mineral and electrolyte replacements/supplements
✓Dosage/Route/Frequency: 1 gram of calcium gluconate contains 90 mg elemental calcium (4.5 mEq calcium).
✓Action: Essential for nervous, muscular, and skeletal systems.
Maintain cell membrane and capillary permeability.
Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Essential for bone formation and blood coagulation.
✓Side Effects: CNS: headche, tingling
CV: syncope, CARDIAC ARREST, arrhythmias, bradycardia
GI: constipation, nausea, vomiting
GU: calculi, hypercalciuria
Local: phlebitis
✓Nursing Implications:(Considerations) PO: Monitor BP, pulse, and ECG frequently throughout parenteral therapy. May cause vasodilation with resulting hypotension, bradycardia, arrhythmias, and cardiac arrest. Transient increases in BP may occur during IV administration, especially in geriatric patients or in patients with hypertension.
RH Immune Globulin
✓Trade Name: RhoGAM
✓Classification: vaccines/immunizing agents
✓Dosage/Route/Frequency: Following Delivery
IM: (Adults) HyperRHO S/D Full Dose, RhoGAM- 1 vial standard dose (300 mcg) within 72 hr of delivery.
Before Delivery
IM: (Adults) HyperRHO S/D Full Dose, RhoGAM- 1 vial standard dose (300 mcg) at 26-28 wk.
✓Action: Prevention of antibody response and hemolytic disease of the newborn (erythroblastosis fetalis) in future pregnancies of women who have conceived a Rho(D)-positive fetus.
✓Side Effects: CNS: dizziness, headache
CV: hypertension, hypotension
Derm: rash
GI: diarrhea, nausea, vomiting
GU: acute renal failure
Hemat: ITP: DISSEMINATED INTRAVASCULAR COAGULATION, INTRAVASCULAR HEMOLYSIS, anemia
MS: arthralgia, myalgia
Local: pain at injection site
Misc: fever
✓Nursing Implications:(Considerations) Assess vital signs periodically during therapy in patients receiving IV Rho(D) immune globulin.
Folic Acid
✓Trade Name: vitamins, water soluble vitamins
✓Classification: vaccines/immunizing agents
✓Dosage/Route/Frequency: PO, IM, IV 1mg/day initial dose then 0.5 mg/day maintenance dose.
✓Action: Prevention of antibody response and hemolytic disease of the newborn (erythroblastosis fetalis) in future pregnancies of women who have conceived a Rho(D)-positive fetus.
✓Side Effects: rash, irritability, difficulty sleeping, malaise
✓Nursing Implications:(Considerations) monitor plasma folic acid levels periodically through therapy
Ferrous Sulfate/ Ferrous Sequel
✓Trade Name: Ferrous Sulfate
✓Classification: antianemics
✓Dosage/Route/Frequency: PO 27 mg/day
✓Action: Treatment and prevention of iron deficiency anemia
✓Side Effects: constipation, black/red tarry stools
✓Nursing Implications:(Considerations) Take with vitamin c for better absorption, drink liquid iron through straw to avoid staining teeth
butorphenol
✓Trade Name: Stadol
✓Classification: opioid analgesic, opioid agonist/anatagonist
✓Dosage/Route/Frequency: IM dose 1-2 mg every 4 hours IV dose 0.5-2 mg every 4 hours
✓Action: Analgesia during labor. Binds to opiate receptors in the CNS. Alters the perception and response to painful stimuli while producing generalized CNS depression.
✓Side Effects: sedation dizziness fainting hypotension hypertension
✓Nursing Implications:(Considerations) : assess pain prior to and 1 hr following, Assess LOC VS Respiratory Rate < 10 assess level of sedation. Assess bowel function. Narcan is respiratory depress ion antidote. Orthostatic hypotension-change positions slowly. Crosses placenta and breast milk – may cause respiratory depression in new born.
Nalbuphine hydrochloride
✓Trade Name: Stadol
✓Classification: opioid analgesic, opioid agonist/anatagonist
✓Dosage/Route/Frequency: : Adults 10-20 mg every 3-6 hours PRN SQ/IM/IV
✓Action: Used for moderate to severe pain during labor. Analgesia. Synthetic opioid analgesic with weak agonist properties. Binds to opiate receptors in the CNS. Alters the perception and response to painful stimuli while producing generalized CNS depression.
✓Side Effects: Respiratory depression, dizziness
✓Nursing Implications:(Considerations) : Observe for signs of hypersensitivity, monitor I&O, asses RR before giving notify provider if below 12, prolonged use with abrupt discontinuation can result in symptoms consistent with opioid withdrawal.
sodium citrate and citric acid
✓Trade Name: Bicitra
✓Classification: antiurolithics
✓Dosage/Route/Frequency: 10-30 mL solution diluted in water 4 times daily.
✓Action: Provision of bicarbonate in metabolic acidosis.
Alkalinization of the urine, Prevention of cystine and urate urinary calculi.
Prevention of aspiration pneumonitis
✓Side Effects: diarrhea, tetany, fluid overload, hypernatremia (severe renal impairment), hypocalcemia, metabolic alkalosis
✓Nursing Implications:(Considerations) : Assess patient for signs of alkalosis (confusion, irritability, paresthesia, tetany, altered breathing pattern) or hypernatremia (edema, weight gain, hypertension, tachycardia, fever, flushed skin, mental irritability) throughout therapy.
metoclopramide
✓Trade Name: Reglan
✓Classification: antiemetics
✓Dosage/Route/Frequency: 10-15 mg 30 min before meals and at bedtime (not to exceed 0.5 mg/kg/day). A single dose of 20 mg may be given preventively.
✓Action: Decreased nausea and vomiting, Decreased symptoms of gastric stasis, Easier passage of nasogastric tube into small bowel.
✓Side Effects: drowsiness, extrapyramidal reactions, restlessness, arrhythmias, constipation, diarrhea, dry mouth, nausea
✓Nursing Implications:(Considerations) : Assessfor nausea, vomiting, abdominal distention, and bowel sounds before and after administration, Monitor for tardive dyskinesia, assess for signs of depression.
meperidine
✓Trade Name: Demerol
✓Classification: opioid analgesic
✓Dosage/Route/Frequency: IV 2.5-15 mg every 4 hours IM/SC 5-20 mg every 4 hours
✓Action: Opioid analgesics/decrease in mild to moderate pain by binding to opiate receptors in the CNS. Analgesic during labor.
✓Side Effects: SEIZURES, confusion, sedation, hypotension, constipation, nausea, vomiting
✓Nursing Implications:(Considerations) : respiratory depression may occur in the newborn)
Do not use in patients receiving MAO inhibitors or procarbazine (may cause fatal reaction–contraindicated within 14-21 days of MAO inhibitor therapy) Assess: BP Pulse, R. If R is < 10/min, assess level of sedation. Assess Bowel function. Monitor patients on chronic or high-dose therapy for CNS stimulation (restlessness, irritability, seizures) Risk of toxicity increases with doses >600 mg/24 hr, chronic administration (>2 days), and renal impairment.
terbutaline sulfate
✓Trade Name: Brethine
✓Classification: adrenergics
✓Dosage/Route/Frequency: IV 2.5-10 mcg/min infusion; Increase by 5 mcg/min q 10 min. until contractions stop (do not exceed 30 mcg/min) After contractions have stopped for 30 min reduce infusion rate to lowest effective amount and maintain for 4-8 hr.
✓Action: Relaxes muscles in the uterus. Management of pre-term labor. Used to arrest labor.
✓Side Effects: angina or chest pain, irregular heartbeats or a fluttering heart, seizures, tremor, weakness, headache, nausea, and vomiting
✓Nursing Implications:(Considerations) : Monitor maternal pulse and BP, frequency and duration of contractions and FHR. Notify provider if contractions persist or increase in frequency or fetal distress occur. Assess maternal respiratory status for symptoms of pulmonary edema. Monitor mother and neonate for symptoms of hypoglycemia (chills; cold sweats; anxiety; confusion; hunger; difficulty concentrating).
Carboprost Tromethamine
✓Trade Name: Hemabate
✓Classification: oxytocics
✓Dosage/Route/Frequency: IM 250 mcg every 1.5-3 hours, may be increased to 500 mcg if several doses of 250 mcg is inadequate Not to exceed 2 days of continuos therapy or total dose of 12 mg)
✓Action: produces strong, prompt, contractions of uterine smooth muscle, possibly mediated by calcium and cAMP. used to terminate pregnancy between 13-20 weeks gestation. Also used for postpartum hemorrhage from uterine atony
✓Side Effects: uterine rupture, wheezing
✓Nursing Implications:(Considerations) : Notify physician if contractions are absent or last more than 1 minute. Monitor temp, BP and pulse periodically. Large doses can cause hypertension. Monitor amount and type of discharge. Report signs of hemorrhage. pretreating patient with antiemetics and antidiarrheals decrease risk of GI effects
Fentantyl
✓Trade Name: Sublimaze
✓Classification: opioid agonists
✓Dosage/Route/Frequency: IV/IM: 50-100mcg/dose q1-2h as needed (adjunct to general anesthesia: 2-50mcg/kg), Buccal (general): 100mcg, Buccal Soluble Film: 200mcg-1200mcg (no more than 4 doses per day, separate by at least 2 hours), Transdermal: 25mcg/hr initially, may increase after 3 days, Transmucosal: 200-400mcg for breakthrough pain, Epidural: Bolus of 100mcg followed by continuous infusion of 10mcg/ml concentration at 4-12ml/hr
✓Action: Supplement in anesthesia. Used to decrease pain. Binds to opiate receptors in the CNS altering the response and perception of pain.
✓Side Effects: Respiratory depression
✓Nursing Implications:(Considerations): Establish baseline B/P and respirations. Assess type, location, intensity, and duration of pain. Resuscitative equipment and opiate antagonist (naloxone 0.5 mcg/kg) must be available. Assist with ambulation, monitor respiratory rate, B/P, heart rate, O2 Sats. Assess for pain relief. Increase fluids and administer stool softener to prevent constipation.
hydroxyzine
✓Trade Name: Vistaril
✓Classification: adrenergics
✓Dosage/Route/Frequency: : PO 25-100mg 4 times /day, max 600mg/day; IM 0.5-1 mg q 4-6hr
✓Action: postpartum mood disorders, sedation, to potentiate opioid analgesics, pruritis, allergic reaction. Depresses sub-cortical levels of CNS, including limbic system, reticular formation; competes with H1-receptor sites
✓Side Effects: extreme drowsiness
✓Nursing Implications:(Considerations): Instruct patient to avoid driving & alcohol, rise slowly, do not stop taking abruptly. assess mental status, PO take with food/milk, IM use Z-track method in large muscle, never give IV/subQ, assist with ambulation.
Lidocaine
✓Trade Name: Xylocaine
✓Classification: anesthetics
✓Dosage/Route/Frequency: : IV 1-1.5 mg/kg bolus, may repeat doses of 0.5-0.75 mg/kg, 5-10 minutes up to 3 mg/kg may then start continuous infusion of 1-4 mg/min
✓Action: Local anesthesia. Can be given in an epidural (spinal block) to reduce the discomfort of contractions during labor. Produces local anesthesia by inhibiting transport of ions across neuronal membranes preventing initiation and conduction of normal nerve impulses
✓Side Effects: blurred vision, nausea vomiting, ringing in your ears muscle twitches, uneven heartbeats, seizure (convulsions), slowed breathing, or respiratory failure (breathing stops).
✓Nursing Implications:(Considerations) : Monitor ECG, BP, and respiratory status continuously during administration. Assess degree of numbness to affected part. If symptoms of overdose occur stp infusion and monitor patient closely.
Oxycodone and acetaminophen
✓Trade Name: Percocet
✓Classification: opioid analgesics
✓Dosage/Route/Frequency: 5-10 mg q 3-4 hr initially, as needed. Controlled-release tablets (Oxycontin) may be given q 12 hr.
✓Action: 5-10 mg q 3-4 hr initially, as needed. Controlled-release tablets (Oxycontin) may be given q 12 hr.
✓Side Effects: Resp: RESPIRATORY DEPRESSION, constipation, confusion, sedation, dizziness, orthostatic hypotension
✓Nursing Implications:(Considerations) : Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use. Assess type, location, and intensity of pain prior to and 1 hr (peak) after administration
dinoprostone
✓Trade Name: Cervidil
✓Classification: oxytocicsprostglandins
✓Dosage/Route/Frequency: Endocervival 0.5 mg may repeat in 6 hours not to exceed 1.5 mg/24 hour. Vaginal insert one 10 mg insert.
✓Action: Produces contractions similar to those occurring during labor at term by stimulating the myometrium. Initiates softening, effacement and dilation of the cervix.
✓Side Effects: amniotic fluid embolism, fever, back pain, uterine rupture, uterine hyper stimulation,
✓Nursing Implications:(Considerations) : Monitor amount and type of discharge. Notify healthcare professional if symptoms of hemorrhage occur. For cervical monitor uterine activity, fetal status, and dilation and effacement of cervix. Insert should be removed at the onset of active labor.
Gentamicin
✓Trade Name: Gentamycin
✓Classification: aminoglycoside
✓Dosage/Route/Frequency: neonate/infant IM/IV 2.5 mg/ kg q 8 to 12 hours. Neonate less than 1 week IV 2.5 mg/kg q 12 to 24 hours
✓Action: Inteferes with protein synthesis in bacterial cell by binding to ribosomal subunit, causing misreading of genetic code, causing bacterial death. For severe systemic infections of CNS, respiratory, GI, urinary tract, bone and soft tissue
✓Side Effects: seizures, neurotoxicity, hypo/hypertension, ototoxicity, oliguria, hematuria, nephrotoxicity, agranulocytosis, thrombocytopenia, rash, urticaria, photosensitivity
✓Nursing Implications:(Considerations) : Weight before treatment, I&O ratio, assess IV site, serum peak, urine pH, renal function, culture and sensitivity before start of treatment, overgrowth of infection, evaluate 8th cranial nerve dysfunction (ringing, roaring in ears, vertigo, assess hearing before during and after), vestibular dysfunction (N/V, dizziness, HA)
Ampicillin
✓Trade Name: Ampicillin
✓Classification: anti-infectives
✓Dosage/Route/Frequency: PO 250 to 500 mg q 6 hours, IM/IV 500 mg q 6 hours
✓Action:inhibits cell wall synthesis during bacterial multiplication. Used to treat. uncomplicated gonorrhea. Prevention of infection in certain high risk patients undergoing cesarean section.
✓Side Effects: : confusion, behavior changes, a severe skin rash, urinating less than usual, or seizure (black-out or convulsions).
✓Nursing Implications:(Considerations) : monitor sodium. monitor for bacterial or fungal superinfection. watch for rash, fever, chills which may indicate allergic reaction. Obtain a history before starting therapy to determine previous use and reactions to penicillins or cephalsporins.
Penicillin
✓Trade Name: Penicillin
✓Classification: anti-infectives
✓Dosage/Route/Frequency: Most infections- 1-5 million units q 4-6 hr.
✓Action: Bactericidal action against susceptible bacteria.
✓Side Effects: SEIZURES, iarrhea, epigastric distress, nausea, vomiting, rash
✓Nursing Implications:(Considerations) : Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing)
Hydralazine
✓Trade Name: Apresoline
✓Classification: antihypertensives
✓Dosage/Route/Frequency: 10 mg 4 times daily initially. After 2-4 days may ↑ to 25 mg 4 times daily for the rest of the 1st week
✓Action: Lowering of BP in hypertensive patients and decreased afterload in patients with HF.
✓Side Effects: dizziness, diarrhea, nausea, vomiting, rash, tachycardia
✓Nursing Implications:(Considerations) : Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy
Methyldopa
✓Trade Name: Aldomet
✓Classification: antihypertensives
✓Dosage/Route/Frequency: PO 250 to 500 mg 2-3 times daily. IV 250 to 500 mg q 6 hours (up tp 1 g q 6 hours)
✓Action: Stimulates CNS alpha adrenergic receptors, producing a decrease in sympathetic outflow to heart, kidneys and blood vessels. Results in decreased BP. Used for conrol of chronic hypertension in pregnancy.
✓Side Effects: drug induced hepatitis, myocarditis, depression, eosinophilia
✓Nursing Implications:(Considerations) : Monitor temperature during therapy. Drug fever may occur shortly after start of therapy. Monitor hepatic function test if unexplained fever occurs. Assess patients for depression or other changes in mental status. Notify health care professional if these symptom develop. Report weight gain and edema, monitor I &O
Nifidepine
✓Trade Name: Adalat
✓Classification: antihypertensives
✓Dosage/Route/Frequency: PO 10 to 30 mg 3 times daily
✓Action: Blocks the passage of calcium into certain tissues, relaxing the uterine muscles and smooth muscle of blood vessels throughout the body. Used to treat pre-term labor when regular contractions of the uterus have thinned the cervix and opened it less than 4 cm and amniotic sac has not broken. When labor needs to be delayed 24 to 48 hours.
✓Side Effects: severe dizziness, pounding heartbeats, nausea, vomiting
✓Nursing Implications:(Considerations) : Assess for rash periodically may cause Steven Johnson syndromeAvoid administration with grapefruit juice, monitor BP and pulse before therapy, during dose titration. Monitor I&O and daily weight.
amethopterin
✓Trade Name: Methotrexate
✓Classification: antirheumatics
✓Dosage/Route/Frequency: 50 mg/m2 X BSA for total mg dose
✓Action: Interferes with folic acid metabolism. Results in inhibition of DNA synthesis and cell reproduction. stops the growth of rapidly dividing cells, such as embryonic, fetal, and early placenta cells. Interferes with the growth of the placenta, which allows it to separate from the endometrium. Used to end an early ectopic pregnancy. Prevent the growth of any embryonic or fetal cells that are left behind after surgery to end an ectopic pregnancy.
✓Side Effects: stomatitis, dizziness, gastritis, conjunctivitis
✓Nursing Implications:(Considerations) :
AZT
✓Trade Name: Methotrexate
✓Classification: antirheumatics
✓Dosage/Route/Frequency: PO, 100 mg 5 times daily until labor, IV 2mg/kg over 1 hour then continuous infusion of 1 mg/kg until umbilical cord is clamped.
✓Action: HIV infection. Reduction of maternal/fetal transmission of HIV.
✓Side Effects: seizures, hepatomegaly, lactic acidosis, pancreatitis
✓Nursing Implications:(Considerations) : monitor serum amylase, lipase and triglycerides elevated serum levels may indicate pancreatitis.
Prostaglandin
✓Trade Name: PGE2
✓Classification: oxytocicsprostglandins
✓Dosage/Route/Frequency: Endocervival 0.5 mg may repeat in 6 hours not to exceed 1.5 mg/24 hour. Vaginal insert one 10 mg insert.
✓Action: Produces contractions similar to those occurring during labor at term by stimulating the myometrium. Initiates softening, effacement and dilation of the cervix
✓Side Effects: amniotic fluid embolism, fever, back pain, uterine rupture, uterine hypestimulation,
✓Nursing Implications:(Considerations) : monitor amount and type of discharge. Notify healthcare professional if symptoms of hemorrhage occur. For cervical monitor uterine activity, fetal status, and dilation and effacement of cervix. Insert should be removed at the onset of active labor.
Tucks pads
✓Trade Name: Witch Hazel
✓Classification: astringent
✓Dosage/Route/Frequency: Apply externally to the affected area up to 6 times daily or after each bowel movement After application
✓Action: : temporarily relieves the local itching and discomfort associated with hemorrhoids,
aids in protecting irritated ano-rectal areas, temporarily relieves irritation and burning
✓Side Effects: N/A
✓Nursing Implications:(Considerations) : Instruct patient not to exceed recommended daily dose. Do not put directly into rectum by using fingers or mechanical device.
Dermoplast spray
✓Trade Name: Dermoplast spray
✓Classification: anesthetics
✓Dosage/Route/Frequency: spray to affected area not more than 3 to 4 times daily
✓Action: Inhibits initiation and conduction of sensory nerve impulses. Used to relieve perineal pain and discomfort postpartum especially if the patient underwent an episiotomy.
✓Side Effects: N/A
✓Nursing Implications:(Considerations) : Instruct patient to keep the perineal area clean.
Contact doctor if condition worsens. Assess integrity of skin before and during therapy. Assess type, location, and intsensity of pain before and a few minutes after administration.

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