complex maternal/OB meds

complex maternal/OB meds

magnesium sulfate

— MOA → CNS depressant; blocks neuromuscular transmission

— used for seizure prevention in preeclampsia/eclampsia

— tocolytic → med to stop contractions & avoid preterm labor

— ADRs → flushing, warmth, hypotension, respiratory depression, cardiac arrest (relax)

— nursing interventions

• monitor DTRs (intact & not completely absent)

• respiratory rate >12/min

• urine output >30mL/hr

• continuous fetal monitoring — IV infusion pump required

• report muscle weakness, difficulty breathing & extreme drowsiness

— contraindications → myasthenia gravis, heart block, renal failure

labetalol (hydralazine, nifedipine)

— used for hypertension during pregnancy

— ADRs → bradycardia, hypotension, fatigue, bronchospasm, dizziness, SOB → report

— nursing interventions

• monitor maternal BP & HR during IV admin

• assess fetal HR — could cause bradycardia

• HOLD if HR < 60 & SBP < 90

• monitor blood glucose — may mask hypoglycemia symptoms

— drug interactions → calcium channel blockers & insulin

— BP goals → maintain below 140/90 & under 160/110 to prevent stroke

oxytocin

— used for labor induction & prevention of postpartum hemorrhages

— first line treatment for postpartum hemorrhage d/t uterine atony (compresses blood vessels)

— ADRs → hypotension, tachycardia, N/V, water intoxication/hyponatremia (electrolyte)

— nursing interventions

• administer via IV pump — NEVER IV push

• monitor uterine tone, fundal height & lochia (discharge)

• REPORT severe cramping, heavy bleeding, dizziness

• precautions → cardiovascular disease w/ prolonged admin (>24hrs)

• CONTRAINDICATIONS → fetal distress during labor

• drug interactions → vasopressors (increase HTN) & anesthesia (hypotension)

misoprostol (2)

— used to induce labor & prevention/treatment of postpartum hemorrhage when oxytocin is unavailable or ineffective

— ADRs → DIARRHEA & FEVER

— nursing interventions

• monitor uterine tone, bleeding, temp & for excessive cramping

• provide comfort measures → GI upset

• expect cramping & fever/chills → normal response d/t diarrhea

• REPORT bleeding

• drug interactions → antacids (reduce absorption if given orally)

methergine

— used for prevention & treatment for postpartum hemorrhage & uterine stony management

— ADRs → hypertension, headache, severe vasoconstriction (with IV route)

— nursing interventions

• check BP before each dose — HOLD if >140/90

• monitor uterine tone & vaginal bleeding

• IV route ONLY in life threatening emergency

• monitor for signs of ergotism (numbness, tingling in extremities)

• REPORT severe headache (educate that it’s expected) & chest pain

• CONTRAINDICATIONS → HYPERTENSION & preeclampsia

hemabate

— used for postpartum hemorrhage when other treatments fail & treatment for uterine atony

— ADRs → diarrhea (common) & bronchospasm

— nursing interventions

• monitor for bronchospasm (especially first 15-30 min)

antimicrobials

— used for chorioamnionitis, postpartum endometritis, wound infection, sepsis

— ADRs → diarrhea/c diff, rash, hypersensitivity reaction, nephrotoxicity, ototoxicity

— report diarrhea, rash, ototoxicity (ringing ears), decreased urine output (nephrotoxicity)

— nursing interventions

• obtain cultures before first dose

• monitor renal function & gentamicin peak/trough levels

• assess ototoxicity risk → esp gentamicin

• monitor for allergic reaction

• administer on time to maintain therapeutic levels

— precautions → renal impairment & history of c diff

— contraindication → myasthenia gravis