Labor, Delivery and Preterm Neonatal Drugs Dena Evans, EdD(c), MPH, BSN, RN, CNE Assistant Professor Department of Nursing The University of North Carolina at Pembroke

 Four First (3 sub-phases)  Effacement and dilation  Latent0-4 cm  Active4-7 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 2 nd stage No effect on FHR or client’s vital signs  Regional-No loss of conciousness Paracervical-1 st stage-not widely used Pudendal-2 nd stage Caudal-After labor well-established-not widely used Spinal-Immediately before delivery or late 2 nd 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 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