labor, delivery and preterm neonatal drugs dena evans, edd(c), mph, bsn, rn, cne assistant professor...
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Labor, Delivery and Preterm Neonatal Drugs
Dena Evans, EdD(c), MPH, BSN, RN, CNEAssistant ProfessorDepartment of NursingThe University of North Carolina at Pembroke
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Four • First (3 sub-phases)
Effacement and dilation Latent 0-4 cm Active 4-7 cm Transition 8-10 cm
• Second Pelvic
Complete dilation and delivery• Third
Placental separation and delivery• Fourth
Stabilization and bonding
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Stronger, longer, more frequent contractions
Pain increases due to:• Cervical dilation• Effacement• Hypoxia of contracting myometrium• Perineal pressure
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Physiologic Psychologic Social Culture Past experience with pain Anticipation Fear Anxiety
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Ambulation Supportive positioning Touch/massage Hygiene and comfort measures Involving support persons Breathing and relaxation TENS Hypnosis Accupuncture Hydrotherapy Herbal supplements ---CAUTION
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Sedative-tranquilizers Narcotic Agnonists Opioids with mixed narcotic
agonist/antagonist effects
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• Given at onset of contractions to ↓ fetal exposure
meperidine (Demerol) fentanyl (Sublimaze) morphine sulfate nalbupine (Nubain) butorphanol (Stadol)
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Local• Perineal Infiltration-before delivery or late
2nd stage• No effect on FHR or client’s vital signs
Regional-No loss of conciousness• Paracervical-1st stage-not widely used• Pudendal-2nd stage• Caudal-After labor well-established-not
widely used• Spinal-Immediately before delivery or late
2nd stage
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RISKS: Hematoma, infection, trauma to sciatic nerve, rectal puncture.
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Chloroprocaine Tetracaine Lidocaine Bupivacaine Ropivacaine
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Hypotension, nerve injury, respiratory impairment (if given too high), headache.
Remember the spinal headache. Should lie flat after procedure.
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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.
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Cesarean Forceps delivery Postpartum for traumatic lacerations Removal of retained placenta
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Umbilicus to toes (vaginal) Xyphoid process to toes (C-section)
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Hypotension, nerve injury, headache (dura puncture), hematoma, impaired respirations (if given too high).
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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
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T12-S5 (entire pelvis)
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Know
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Aortocaval compression Wedge Left lateral position Inferior vena cava and aortic
compression Hypotension
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Titrated based on uterine and fetal response
Need to establish adequate contraction pattern which promoted labor progress
Contractions every 2-3 minutes lasting 50-60 seconds/moderate intensity
Prevents uterine atony after delivery
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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
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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.
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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).
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PO. IV not recommended unless emergency
IV: Assess hypertension Client already has HTN or PVD-should
not receive
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Uterine cramping N/V Hypertension (IV administration) Chest pain, Dyspnea Sudden and severe headache
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Ergotism Pain in arms, legs, lower back Numbness, cold hands and feet Blood hypercoagulation Hallucinations
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Know Important: Notify MD if systolic BP
increases by 25mm/Hg or diastolic 20mm/Hg over baseline.
Teaching client that this may inhibit lactation.
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Prevents the development of respiratory distress syndrome
Surfactant-keeps alveoli open during expiration
Also given in clients already diagnosed with RDS to prevent severity.
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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
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Reflux up ET tube
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Infant• Dusky colored• Agitated• Bradycardic• O2 sats increases of more than 95%• Improved chest expansion• CO2 levels less than 30 mm/Hg
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Know