1. Postpartum and Newborn Drugs
Chapter 55
Postpartum and Newborn Drugs
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2. Drugs Used Postpartum Prevent uterine atony and postpartum hemorrhage
Relieve pain from uterine contractions, perineal wounds, and hemorrhoids
Enhance or suppress lactation
Promote bowel function
Enhance immunity
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3. Drugs Used Postpartum (Cont.)
Nonpharmacologic agents
Pain relief for uterine contractions
NSAIDs
Opioids
Pain relief for perineal wounds and hemorrhoids
Topical and local agents
Witch hazel and dibucaine ointment
Side effects and adverse reactions
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4. Nursing Process: Perineal Wounds and Hemorrhoids
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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5. Drugs Used Postpartum (Cont.)
Lactation suppression
Nonpharmacologic measures more commonly used than pharmacologic agents
Chlorotrianisene (Tace), Deladumone OB, or bromocriptine mesylate (Parlodel)
Pyrioxidine (vitamin B6) for 5 days
Ingesting sage tea approximately every 6 hours
Using 3 to 4 mL of alcohol tincture every 6 hours via the mucous membranes
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

6. Drugs Used Postpartum (Cont.)
Promotion of bowel function
Nonpharmacologic measures
Pharmacologic measures
Stool softeners
Laxative stimulants
Antiflatulents
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7. Nursing Process: Laxatives
Assessment
Nursing diagnosis
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluations
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8. Understanding Rh Isoimmunization
Immunizations
Enhancement of immunity
Understanding Rh Isoimmunization
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9. Immunizations 
Maternal blood is assessed for the D antibody at the initial prenatal laboratory evaluation and at 26 to 28 gestational weeks.
Human D immune globulin (RhoGAM, RhO[D] immune globulin) is routinely administered to women with maternal/fetal blood mixing.
During the postpartum period, D immune globulin should be administered within 72 hours.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

10. Immunizations (Cont.)
Rh sensitization process can be prevented through the administration of RhO(D) immune globulin (RhoGAM) to unsensitized Rh-negative patients after each actual or potential exposure to Rh-positive blood.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

11. Rubella Vaccination Congenital rubella syndrome
There is no treatment for maternal or congenital rubella infection.
The goals are immunization and prevention of rubella in patients of childbearing age.
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12. Nursing Process: Immunizations
Assessment
Nursing diagnosis
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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13. Drugs Administered to Newborn Immediately after Birth
Erythromycin ophthalmic ointment
Vitamin K
Site for Giving an Intramuscular Injection to a Newborn Shortly after Birth.
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14. Immunization During the Newborn Period Before Discharge
Hepatitis B virus (HBV)
HBV transmission occurs vertically, primarily at the time of delivery.
Recombinant hepatitis B (Engerix-B, Recombivax HB)
If appropriate, administer hepatitis B immune globulin (HBIG) injections.
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15. Nursing Process: Drugs Administered to Newborn Immediately after Delivery
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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16. Practice Question #1
Before administration of Rh immune globulin D, what is an appropriate nursing intervention?
To monitor blood pressure
To check for a signed informed consent
To administer an analgesic
To confirm that patient is Rh-positive
Answer: B
Rationale: Obtain patient’s written consent before administration. Some agencies require a refusal form if the drug is declined.
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17. Practice Question #2
The nurse knows that correct instillation of the eye ointment used for newborn eye prophylaxis is
directly onto the cornea.
into the inner canthus of the eye.
into the lower conjunctival sac.
under the upper eyelid.
Answer: C
Rationale: Administer ophthalmic ointment (ribbon of ointment about 1 cm long) from inner canthus to outer canthus in lower conjunctival sac of each eye. Do not touch eye with applicator.
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18. Practice Question #3
A patient experiences postpartum hemorrhoids. The nurse anticipates the initial treatment to include which of the following?
Warm sitz baths
Rectal suppositories
Frequent enemas
Narcotic analgesia
Answer: A
Rationale: A nonpharmacologic treatment such as warm sitz baths would most likely be used for this patient.
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19. Practice Question #4
Which is the most common treatment approach for lactation suppression?
Chlortrianisene (Tace)
Deladumone OB
Bromocriptine mesylate (Parlodel)
Wearing a supportive bra 24 hours a day for 10 to 14 days
Answer: D
Rationale: In the past, lactation was commonly controlled through drug therapy with one of the three agents listed in the options. Presently, nonpharmacologic measures such as wearing a supportive bra 24/7 for 10 to 14 days, breast binding, and axillary ice packs are recommended for lactation suppression.
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20. Practice Question #5
When administering Rho(D) immune globulin, the nurse will
administer the medication by mouth.
administer the drug within 30 days of delivery.
instruct the patient to avoid live virus vaccines for 1 month after administration.
have epinephrine available to treat anaphylaxis.
Answer: D
Rationale: Epinephrine is used to treat anaphylaxis associated with administration of this drug.
Rho(D) immune globulin is normally administered in the deltoid muscle within 72 hours after delivery, but if more than 72 hours has passed, it should be administered as soon as possible up to 28 days; a lesser degree of protection may result. Patients receiving Rho(D) should avoid live virus vaccines for 3 months after administration.
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