1. MATERNITY AND NEWBORN MEDICATIONS
PYRAMID POINTS
CHAPTER 26:
MATERNITY AND NEWBORN MEDICATIONS
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2. PYRAMID POINTS I. Oxytocic Medication: Oxytocin (Pitocin) Description
Stimulates smooth muscle of uterus; induces contractions of the myocardium; promotes milk letdown
Uses
Induces or augments labor; controls postpartum bleeding; promotes milk letdown and facilitates breast-feeding; induces or completes an abortion
Adverse reactions
May include allergies, dysrhythmias, changes in blood pressure, uterine rupture
Contraindications
Should not be used in a woman who cannot deliver vaginally or with hypertonic uterine contractions
MATERNITY NURSING:
Maternity and Newborn Medications
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3. PYRAMID POINTS I. Oxytocic Medication: Oxytocin (Pitocin) (continued)
Interventions
Monitor maternal and fetal status closely, including frequency, duration, force of contractions, fetal heart rate every 15 minutes
Administer medication on intravenous (IV) infusion device only
Do not leave client unattended during infusion
If uterine hyperstimulation or nonreassuring fetal heart rate occurs, stop medication immediately, turn client to side, infuse IV normal saline, administer oxygen via face mask as prescribed; then notify physician
MATERNITY NURSING:
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4. PYRAMID POINTS II. Ergot Alkaloids
Can produce arterial vasoconstriction, vasospasm of coronary arteries
Do not administer before delivery of placenta
Contraindicated during pregnancy and in clients with significant cardiovascular and peripheral vascular disease, hypertension
Monitor maternal vital signs, uterine contractions, signs of bleeding
Monitor temperature, breath sounds every
1 to 2 hours
MATERNITY NURSING:
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5. PYRAMID POINTS III. Prostaglandins
Ripen cervix, stimulate uterine contractions
Adverse reactions
Diarrhea, nausea and vomiting, fever, chills, flushing, dysrhythmias, bronchoconstriction, peripheral vasoconstriction
Contraindications
Should not be given to clients with significant cardiovascular disease or history of asthma, pulmonary disease
Interventions
Monitor maternal vital signs, fetal status, including labor status as it relates to mother and fetus
Before administration, have woman void, then maintain supine or side-lying position for 30 to 40 minutes after administration
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6. PYRAMID POINTS IV. Magnesium Sulfate Description Uses
Central nervous system depressant and anticonvulsant; also causes smooth muscle relaxation, thus decreasing blood pressure
Calcium gluconate is antidote
Uses
Helps stop preterm labor, prevents and controls seizures in preeclamptic and eclamptic clients
Adverse reactions
Respiratory depression, depressed deep tendon reflexes, hypotension, decreased urinary output—symptoms of magnesium toxicity
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7. PYRAMID POINTS IV. Magnesium Sulfate (continued) Contraindications
Should not be used in clients with heart block, myocardial damage, renal failure
Should be used with caution in clients with severe renal impairment
MATERNITY NURSING:
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8. PYRAMID POINTS IV. Magnesium Sulfate (continued) Interventions
Monitor for signs of magnesium toxicity
Have calcium gluconate at bedside
Monitor vital signs, especially respirations, every
30 to 60 minutes
Administer IV infusion via infusion pump or monitoring device
Monitor deep tendon reflexes hourly
Do not administer if client’s patellar reflex absent or respiratory rate below 16 breaths/minute, as prescribed
Monitor hourly intake and output and report hourly output less than 30 mL
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9. PYRAMID POINTS V. Opioid-Agonist Analgesics Description
Used to relieve moderate to severe pain associated with labor
Regular use during pregnancy may produce withdrawal symptoms in neonate
Keep naloxone on hand at all times as antidote
Meperidine hydrochloride (Demerol)
Not administered during advanced labor (within 1hour of delivery)
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10. PYRAMID POINTS V. Opioid-Agonist Analgesics (continued)
Morphine sulfate, hydromorphone hydrochloride (Dilaudid)
May cause respiratory depression
Interventions
Monitor vital signs (especially for respiratory depression), fetal heart rate
Have antidote, naloxone, available at all times
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11. PYRAMID POINTS
VI. Opioid-Agonist Analgesics for Intrathecal and Epidural Use
Potent, short-acting opioid analgesics
Fentanyl citrate (Sublimaze), sufentanil citrate (Sufenta)
Antidote is naloxone
May cause maternal/fetal/neonatal respiratory depression
Interventions
Monitor respirations; if less than 12/minute,
withhold medication and notify registered nurse (RN)
Have antidote available at all times
DT: Bullets are wrong
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12. PYRAMID POINTS VII. Opioid Agonist-Antagonist Analgesics
Butorphanol (Stadol), nalbuphine (Nubain)
Mixed agonist-antagonist analgesic
Less respiratory depression when compared with other opioid agonist analgesics
May cause maternal cardiac rhythm changes
Interventions
Monitor respirations; if less than 12/minute, withhold medication and notify RN
Have antidote, naloxone, available at all times
DT: Bullets are wrong
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13. PYRAMID POINTS VIII. Opioid Antagonist Naloxone (Narcan) Interventions
Blocks receptors from effects of opioid agonists
Quickly reverses central nervous system depressant effects, especially respiratory depression
May cause maternal hypotension and hypertension
Interventions
Monitor vital signs
Recognize that pain will return suddenly
DT: Bullets are wrong
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14. PYRAMID POINTS IX. Rho(D) Immune Globulin (RhoGAM) Description Use
Immunoglobulin that prevents formation of anti-Rho(D) antibodies
Use
Helps prevent isoimmunization in Rh-negative mother who may be exposed to Rh-positive red blood cells of fetus during pregnancy
Adverse reactions
Fever; tenderness at injection site
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15. PYRAMID POINTS IX. Rho(D) Immune Globulin (RhoGAM) (continued)
Contraindications
Should not be given to Rh-positive women
Should not be given to women with history of systemic allergic reactions to preparations containing human immunoglobulins
Should not be administered to newborn infant
Interventions
Administer to mother by intramuscular injection at 28 weeks’ gestation and within 72 hours after delivery for every pregnancy
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16. PYRAMID POINTS
X. Antenatal Corticosteroid Therapy: Betamethasone, Dexamethasone (Decadron)
Description
Corticosteroid; increases production of surfactant
Uses
Clients in preterm labor from 28 to 32 weeks’ gestation whose labor can be inhibited for 48 hours without jeopardizing mother or fetus
Adverse reactions
Immunosuppressive to mother
Contraindications
Should not be used if breast-feeding
Interventions
Monitor maternal vital signs; monitor mother for signs of infection; monitor maternal white blood cell count
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17. PYRAMID POINTS XI. Surfactant Replacements Description Use
Replenish surfactant and restore surface activity and respiratory compliance to lungs
Use
Prevent or treat respiratory distress syndrome in premature infants
Adverse reactions
Transient bradycardia; oxygen desaturation
Contraindications
Should be given with caution to clients at risk for circulatory overload
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18. PYRAMID POINTS XI. Surfactant Replacements (continued) Interventions
Instilled through catheter inserted into infant’s endotracheal tube; avoid suctioning for at least
2 hours after administration
Monitor for bradycardia; frequently assess lung sounds
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19. PYRAMID POINTS XII. Eye Prophylaxis for the Neonate Description Uses
Bacteriostatic and bactericidal ointments and/or eye drops
Uses
Erythromycin (0.5% Ilotycin) and tetracycline (1%) used to prevent infection by Neisseria gonorrhoeae and Chlamydia trachomatis
Silver nitrate (1%) prevents N. gonorrhoeae but does not protect against chlamydial infection; thus, not used as often
Adverse reaction
Silver nitrate (1%) can cause chemical conjunctivitis
Interventions
Cleanse neonate’s eyes before instilling drops or ointment; instill within 1 hour after delivery
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20. PYRAMID POINTS XIII. Vitamin K (AquaMEPHYTON) Description Uses
Vitamin K necessary to help production of active prothrombin; newborns are deficient in vitamin K for first
5 to 8 days of life because of lack of intestinal flora necessary to absorb vitamin K
Uses
Prophylaxis, treatment of hemorrhagic disease of newborn
Adverse reaction
Hyperbilirubinemia in newborn
Interventions
Administer in vastus lateralis muscle early in neonatal period
Monitor for bruising, signs of bleeding
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21. 1. Prevent spontaneous delivery. 2. Stop the uterine contractions.
1. A client experiencing preterm labor at 29 weeks’ gestation has been admitted to the hospital, and has an order to receive betamethasone. The nurse plans to tell the client that the medication will do which of the following?
1. Prevent spontaneous delivery.
2. Stop the uterine contractions.
3. Promote maturation of the fetal lungs.
4. Accelerate the growth rate of the fetus.
Answer: 3
Rationale: Betamethasone is classified as an anti-inflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone to allow time for the lungs of the fetus to mature.
Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind, eliminate options 1 and 2. Specific knowledge about the medication is needed to make the final selection. Note the strategic words “29 weeks’ gestation.” Knowledge of the problems encountered by premature infants will also assist in answering this question. Review this medication if this question was difficult.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pharmacology
Reference: Lehne, R. (2007). Pharmacology for nursing care (6th ed., p. 828). Philadelphia: Saunders.
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22. 2. The nurse has a routine order to administer an injection of
vitamin K to the newborn. Before giving the medication, the
nurse explains to the mother that this medication will:
1. Supplement the infant, because breast milk and formula are low in vitamin K.
2. Stimulate the liver to produce vitamin K.
3. Prevent vitamin deficiency of fat-soluble vitamins.
4. Prevent clotting abnormalities in the newborn.
Answer: 4
Rationale: Vitamin K is given to the newborn to prevent clotting abnormalities. It is usually produced by bacteria in the gastrointestinal tract, which is sterile in the newborn. The other options are incorrect.
Test-Taking Strategy: Use the process of elimination. Begin to answer this question by eliminating options 1 and 2 because they are the least plausible of all the options. Choose option 4 over option 3 by knowing that vitamin K is only one of four fat-soluble vitamins. Review the rationale for this type of newborn prophylaxis if this question was difficult.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pharmacology
Reference: Lehne, R. (2007). Pharmacology for nursing care (6th ed., p. 931). Philadelphia: Saunders.
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