labor, delivery and preterm neonatal drugs dena evans, edd(c), mph, bsn, rn, cne assistant professor...
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Labor, Delivery and Preterm Neonatal Drugs
Dena Evans, EdD(c), MPH, BSN, RN, CNEAssistant ProfessorDepartment of NursingThe University of North Carolina at Pembroke
Four • First (3 sub-phases)
Effacement and dilation Latent 0-4 cm Active 4-7 cm Transition 8-10 cm
• Second Pelvic
Complete dilation and delivery• Third
Placental separation and delivery• Fourth
Stabilization and bonding
Stronger, longer, more frequent contractions
Pain increases due to:• Cervical dilation• Effacement• Hypoxia of contracting myometrium• Perineal pressure
Physiologic Psychologic Social Culture Past experience with pain Anticipation Fear Anxiety
Ambulation Supportive positioning Touch/massage Hygiene and comfort measures Involving support persons Breathing and relaxation TENS Hypnosis Accupuncture Hydrotherapy Herbal supplements ---CAUTION
Sedative-tranquilizers Narcotic Agnonists Opioids with mixed narcotic
agonist/antagonist effects
• Given at onset of contractions to ↓ fetal exposure
meperidine (Demerol) fentanyl (Sublimaze) morphine sulfate nalbupine (Nubain) butorphanol (Stadol)
Local• Perineal Infiltration-before delivery or late
2nd stage• No effect on FHR or client’s vital signs
Regional-No loss of conciousness• Paracervical-1st stage-not widely used• Pudendal-2nd stage• Caudal-After labor well-established-not
widely used• Spinal-Immediately before delivery or late
2nd stage
RISKS: Hematoma, infection, trauma to sciatic nerve, rectal puncture.
Chloroprocaine Tetracaine Lidocaine Bupivacaine Ropivacaine
Hypotension, nerve injury, respiratory impairment (if given too high), headache.
Remember the spinal headache. Should lie flat after procedure.
Nursing: Make sure your client is well-hydrated. Placed in side-lying position for administration. Monitor BP every 1-2 minutes for the first 10 minutes after administration. Assess analgesia.
Cesarean Forceps delivery Postpartum for traumatic lacerations Removal of retained placenta
Umbilicus to toes (vaginal) Xyphoid process to toes (C-section)
Hypotension, nerve injury, headache (dura puncture), hematoma, impaired respirations (if given too high).
Clients should be well-hydrated Assess dizziness, tinnitus, metallic taste or
toxic response (indicates vein injection). Assess BP Mother on L side if hypotension occurs Assess level of analgesia After delivery-motor strength prior to
ambulation Assess for presence of bilateral analgesia
T12-S5 (entire pelvis)
Know
Aortocaval compression Wedge Left lateral position Inferior vena cava and aortic
compression Hypotension
Titrated based on uterine and fetal response
Need to establish adequate contraction pattern which promoted labor progress
Contractions every 2-3 minutes lasting 50-60 seconds/moderate intensity
Prevents uterine atony after delivery
Avoid Increased pain Compromised FHT patterns Must use infusion pump Half life is 1-9 minutes Onset: 3-5 minutes unless IV then
immediate Duration: 2-3 hours
Assess: consent, confirm gestation, collect baseline data, contraindications?
Diagnoses: Deficient knowledge Planning Interventions: Have agents and O2
available; Monitor I&O; Monitor VS, Monitor FHR; Monitor infusion, positioning
Evaluation: Effective labor progress, report changes in vital signs, FHR.
Not used during labor Given after delivery to prevent or
control postpartum hemorrhage and promote uterine involution (return to pre pregnancy size).
Ergonovine maleate (Ergotrate Maleate) and methylergonovine maleate (Methergine).
PO. IV not recommended unless emergency
IV: Assess hypertension Client already has HTN or PVD-should
not receive
Uterine cramping N/V Hypertension (IV administration) Chest pain, Dyspnea Sudden and severe headache
Ergotism Pain in arms, legs, lower back Numbness, cold hands and feet Blood hypercoagulation Hallucinations
Know Important: Notify MD if systolic BP
increases by 25mm/Hg or diastolic 20mm/Hg over baseline.
Teaching client that this may inhibit lactation.
Prevents the development of respiratory distress syndrome
Surfactant-keeps alveoli open during expiration
Also given in clients already diagnosed with RDS to prevent severity.
beractant Survanta calfactant Infasurg proactant alfa Curosurf **All products require intubation for
administration and specific positioning to ensure proper disbursement
Those adventitious breath sounds may be present after administration—unless respiratory distress—No suction x 2 hours
Reflux up ET tube
Infant• Dusky colored• Agitated• Bradycardic• O2 sats increases of more than 95%• Improved chest expansion• CO2 levels less than 30 mm/Hg
Know
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