MEDICATIONS FOR THE REPRODUCTIVE

What are some factors that influence choice of a contraceptives ?

-age and health status

-religon and culture

-plans for future conception

-frequency of intercourse

-number of sexual partners

-personal concers about avaliablity spintenity and ease of use

What are some consideration rhythm method (calendar method)?

-develop fertile awareness by noting

-cervical mucus changes

-menstural cycle pattern

-basal temperature

What is some client education for patients using the rhytm method?

-dont have sexual intercourse during fertile periods

-low reliablity for prevening pregnancy

What are some considerations for patients using oral contraceptives?

-pill is taken daily

-adverse effects

• breast tenderness

• bleeding

• nausea/vomiting

What patient education can you give patients using oral contraceptives ?

-antiobiotic therapy

-phenytoin and rifampin

-reduce effectiveness

-avoid smoking

What some considerations for patients using ethinyl estradiol and norelgestromin (contraceptive patch) ?

-replace patch each week for 3 weeks

what patient education can you give a patient on the contraceptive patch ?

-apply patch to the buttocks

-abdomen

-upper torso

-upper /outer torso

-period will begin on week 4 (no patch)

What are some considerations for patients using medroxyprogesterone ?

-injection is adminstered every 3 months during the menstural cycle

What patient education can you give a patient using medroxyprogestrone ?

-use backup form of birth control for 7 days after first injection

-fertility returns approximately 1 year after shopping

What are some considerations for emergency contraception?

-a larger than normal dose of oral contraceptive

-patient should take no later 72 hours after unprotected sex

-second dose is repeated 12 hours

-antienmetics may be needed

What patient education can you a patient taking emergency contraception?

-should discuss options with provider

-should never be used as the primary method of birth control

What are some considerations for patients using etonogestrel, ethinyl estradiol, and vaginal ring?

-placed deep into the vagina once every 3 weeks

what patient education can you give patient using etonogestrel, ethinyl estradiol, and vaginal ring?

-one size fits most women

-if falls out rinse with warm water and replace within 3 hrs

-remove ring during week 4; mensus should begin

What are some considerations for patients using an IUD?

-it is contraindicated for women with diabetes ir history of PID

-risk of infection

-may have cramping and heavier periods

what patient education can you give patient using IUD ?

-hormone IUD effective for up to 5 years

-copper IUD effective for up to 10 years

-must monitor the patient for signs of infections

-verify string is present

What are some considerations for patients using a cervical diaphragm ?

-use with spermicide

-fit it by a prescriber

-refitted after childbirth weight gain or less

what patient education can you give patient using a cervical diapgragm?

-insert 6 hours prior to and leave in for 6 hours after intercourse

-may be inserted up to 6 hours prior to intercourse

-leave in for 6 hours after intercourse

-refit size with 10 lb or more weight changes and after childbirth

What are some considerations for patients using an condoms ?

use with spermicide

what patient education can you give patient using condoms ?

-protects against STIs

-apply and remove correctly

-use only water soluble lubricants

What are some considerations for patients using spermicides ?

available as

• Cream

• foam

• gel

• suppository

• film

what patient education can you give patient using spermicides

-should use with barrier method

-can insert up to 1 hour before intercourse

What are some nursing interventions and client education?

-discuss conception and contraceptive plans with patients to include, realiablity, benefis and risks

-intruct the patients to maintain regular health screening visits

-instruct patients about measures to prevent PID,STIs

-explain the contraceptive decisions may change over the life span

-teach the patients unreliable forms of birth control including withdrawal, douching, and breastfeeding

What does oxytocic do?

prostagladins cause cervical softening in preperation for cervical dilation and effacement

What are some oxytocic medications?

-dinoprostone cervical gel

-misoprostol

What are some precautions for oxytocic medications ?

-contraindicated in patients who have acute PID, hx of pelvix surgery, abdominal fetal postion

What are some side effects of oxytocic medications ?

-nausea

-headache

-tremor

-feeling warmth in the vaginal area

-elevated temp

what are some nursing interventions for patients using oxytocic medications ?

-maintain the patient on bed rest for at least 2 hr after insertion

-monitor and record maternal vital signs and fetal heart rate

-monitor for uterine contractions

-oxytocic augmentation may be initaite as needed

-major adverse effecrs is tachysystole

What does oxytoxcin do ?

stimulate uterine contractions for the purpose of induction or augmentation of labor and prevents postpartum hemorrhage

What is the therapuetic use of oxytoxcin ?

-antepartum for contraction stress test

-intrapartum for induction or augmentation of labor

-postpartum to promote uterine tone

What are some precautions of oxytocin ?

-contraindicated with placental abnormalities, fetal malpresentation, previous uterine surgery and fetal distress

-bishop score 6 and greater when planning induction

What are some side effects of oxytocin ?

-intense uterine contractions

-uterine hyperstimulation

-uterine rupture

-water intoxication

What are some nursing interventions of oxytocin ?

-admin as secondary infusion via infusion pump for induction or augmentation

-continuosly monitor uterine contractions and fetal heart

-discontinue oxytocin with any signs of uterine hypersensimulation or signs of maternal or fetal distress

-admin oxygen via face mask 10 L for signs of hyperstimulation

-when used in postportum monitor patient for uterine bleeding

What does methyergonovine do ?

acts directly on the uterine muscle to stimulare forceful contractions

What are some therapeutic uses of methyergonovine ?

pospartum hemorrhage

what are some precautions to using methylergonovine ?

use with extreme caution in patients with hypertension, preecalmpsia,heart disease, venoatrial shunts, mitral valve stenoisis, cardiovascular, sepsis, hepatic or renal impairment

What are some side effecrs to methylergonovine?

-potent vasoconstriction

-hypertension

-headache

What are some nursing interventions for patient taking methylergonovine ?

-continuosuly monitor patients blood pressure

-assess uterine bleeing and uterine tone

What are some tocolytic medications ?

-tetralyline sulfate

-nifedine

-mangesium sulfate

What do tocolytics do ?

act on uterine muscles to cease contractions

What is the therapeutic use of tocolytic medications?

stop preterm labor

what are some side effect of tetrabutaline sulfate ?

-nervousness

-tremulousness

-headache

-nausea

-vomiting

-hyperglycemia

-severe palpataions

-chest pain pulmonary edema

what are some nursing interventions for patients taking terbutaline sulfate ?

-monitor patients contractions and FHT

-monitor vital signs

-do not administer if pulse rate is greater than 130min or patient has chest pain

-admin beta blocker as an antidote

What are some side effects of nifedipine ?

-hypotension

-headache

-nausea

-flushing

What are some nursing interventions for patients taking nifidepine ?

-monitor paitents bp

-monitor patients magnesium levels

-therapuetuc magnesium is 4 to 8 mg/dl

-adminster medication via infusion pump in a diluted form

-use indwelling catheter to monitor urinary elimination

-admin calcium gluconate 10% for signs of toxicity

What are some side effects of magnesium sulfate ?

-warmth

-flushing

-respiratory depression

-diminshed DTRs

-decreased urinary output

-pulmonary edema

What does betamethasone ?

stimulate production of surfactant in fetus betweeen 24 and 34 weeks gestation

What are some side effects of bethamethasone ?

-fluid retention

-elevated blood pressure

-maternal hyperglycemia and transient increase WBC

what are some nursing interventions for bethamethasone?

-admin teo doses 24 hr apart

-provide emotional support to the family

what are some medications for post postpatrum patient?

-RhoGAM

-varciella

What does RhoGAM do?

supress the stimulation of active immunity by Rh-positive foreign red blood cells that enter the maternal circulation at the time of delivery

What is the therapeutic use of RoGHAM ?

Rh factor incompatiablity to prevent sensitization for subsequent pregnancies

What are some precautions for RoGHAM?

-confirm that the mother is Rh negative

-never administer the IGIM full dose or microdose products intravaneously

-never admin to a neonate

What are some nursing interventions for patients using RhoGAM?

-RhoGame is admin within 72 hours after birth if indicated

(mom is Rh - newborn Rh+ and coombs test is negative)

-RhoGAM is also administereed as injection prophylatically at 28 weeks gestation and after any even where fetal cells can mix with maternal blood

(miscarriage,ectopic pregnancy, induce abortion, aminocentesis, chronic villus sampling, abdominal trauma )

What are some nursing considerations for patients getting the varicella vaccine?

-women who are not immune to varicella should be immunized in postpartum period

-educate patients to use reliable form of contraceptions and avoid pregnancy for 3 months