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what are the 4 primary clinical indications for the use of uterine stimulants?
- 1. induction of labor
- 2. control of postpartum atony or hemorrage
- 3. control of postsurgical "c" section
- 4. induction of therapeutic abortion
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examples when inductoin of labor is needed?
precipitous labor and delivery, post-term preg, prolonged preg with placental insufficiency, PROM, PIH
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after delivery how is the uterus?
flaccid and boggy. or loose and weak
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uterine stimulants are sometimes given bc of an atonic uterus, what is this?
when the utreus will not contract back to normal with out help
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when is the uterine smooth muscle responsive to oxytocin?
stimulation does not happen until late in the 3rd trimester
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examples of uterine stimulants?
Prostin E2, Prepidil, cervidil
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waht happens in lower doses of uterine stimulants?
causes cervical dialation and softening
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what happens in higher doeses of uterine stimulants?
its causes increase frequency and strength of contractoins
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higher does instances for stiumulants include?
fetal death, hydatiform mole, spontaneous miscarriage, 2nd trimester abortion
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these to stimulants are used together to shorten the duration of time required to expel uterine contents?
oxytocin and dinoprostone
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this is for cervical ripening?
dinoproston
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dinoproston is a gel, slab and how is it administered?
for gel:at room temp and remain supine 15-30 min for vaginal slab:does not have to be room temp and remain supine for 2 hrs and remove at labor or 12 hrs after insertion
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for evacuation of uterine contents?
aloow to become room temp, remain supine 10 min and may repeat every 2-5 hrs
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what should nurses monitor on dinoproston?
V/S q30 min, hydration status, discharge, n/v/d may need to medicate for this
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Misoprostol (cytotec)
synthetic prostoglandin E used to prevent NSAID induced ulcer disease
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ergovine maleate? methylergonovine?
produce a more sustained contraction than oxytocin and are used in small doeses postpartum pt to control bleeding and maint uterine firmness. Inhibited in induction of labor due to danger to the fetus and such sever prolonged contractions
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Ergonovine is inhibited in PT who?
desire to breast feed
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what may develop from caudal or spinal anesthesia
HTN and HA
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this causes vasocontriction of the uterus?
oxytocin
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produced by the hypothalmus and stored in the posterior pituitary gland, when released it stimulates the smooth muscle of the uterus, blood vessels and mammary glands.
oxytocin
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2 affects of oxytocin?
antidiuretic and vasopressor
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what should you as the nurse monitor when administering oxytocin?
VS BP and pulse, hydration, uterine contractions, FHR, discharge
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when is a safe week to start oxytocin?
27 weeks
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what stops muscle contractions by blocking Ca transmitters?
megnesium sulfate
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magnesium sulfate is what?
tocolytic
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used as antoconvulsant in eclampsia
mag sulfate
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symptoms of toxicity of mag sulfate
hot all over, thirsty, flushed skin, diaphoresis, hypotension, flaccid muscles, confusion, rsp collapse
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antagonist for mag sulfate?
calcium gluconate or you can lavage or give activated charcoal
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infants born to mother who recieve mag sulfate must be monitored for what?
hypotension, hyporeflexia and resp depression
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Terbutaline or brethine?
relaxes smooth muscle and bronchials but may cause tremors, anxiety, HA tachcardia, n/v
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clomiphene citrate (clomid)?
increases pregnancy potential, ovulation and increases the FSH and LH just like a natural estrogen
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5-10% of pts treated with this will have multiple fetus pregnancies
CLOMID
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betamethasone or dexamethasone are what? and administered how? and used for what?
corticosteroids, IM to mother to inhibit preterm labor and minimize resp ditress and accelerate lung maturation
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supresses the stimulation of active immunity by RH-positive foreign RBC that enter the maternal ciculation at the time of delivery, termination or during a transfusion of inadequate blood type
RhoGAM
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when is RhoGAM administered?
within 72 hours of termination of pregnancy
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when should the Rubella vaccine be given?
immediately after birth
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when should you test for group B strep ?
35-37 weeks pregnancy
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erythromycin or tetracycline opthalmic ointment?
caused by gonorrhoeae and c. trachmoatis and should be instilled with in 2 hrs of birth 1/4 ribbon and do not irrigate after instilation
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Vit K?
administered IM to newborn, prevents hemorrhage
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what is responsible in the body for the synthesis of Vit K?
Intestinal flora
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Hep B?
administered IM to newbor, one of first 3 injections and have to have consent
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oxytocin id admin IV or IM and may be given early due to what problems?
Diabetic w large fetus, ROM, PIH, eclampsia, incomplete or inevitable abortion
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adverse reactions of oxytocin?
fetal bradycardia, uterine rupture, hypertonia, n/v, cardiac arrhythmias, shocl, water overload
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pt who are calcium deficient may not respond to what uterine stimulant?
ergonovine which can be replaced by a ca infusion
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how often should vitals be taken while on ergonovine?
q4hr
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when palpating a uterus of a woman on ergonovine is should be how?
small, round and firm
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Hemabate or carboprost?
used in postpartum uterine hemorrhage
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ergonovine
used in uterine atony and hemorrhage
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misoprostol or cytotec?
used in postpartum hemorrhage, cervical ripening and it a vaginal admin tablet
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Pitocin or oxytocin?
used antepartum to initiate or improve uterine contraction; post partum to control bleeding and hemorrhage
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Expect how many firm contraction q10 min followed by relaxation of uterus from admin of oxytocin?
3-4 firm uterine contractions
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upon administration of oxytocin nurse should assess vs and FHR how often
q30 min and q15 min along with contractions
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if contraction last longer than 60 seconds what should the nurse do?
contact dr asap
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other types of tocolytics?
NSAID indomethacin and ritodrine and terbutaline (brethine)
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when using indomethacin we need what test before administratoin?
liver function test and amniotic fluid index
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what side should a pregnant mother lay to reduce orthostatic hypotension?
left side
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you should continue tocolytics how long after contractions cease?
12hrs
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adverse reaction of indomethacin and terbutaline?
tremors, nervous, drowsiness, HA, nausea, yellow coloring of skin or eyes
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uterine atony?
marked relaxation of the uterine muscle
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ergotism?
overdose of ergonvine
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lochia?
vaginal discharge in postpartum
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precipitous labor?
labor that last 3 hours or less from start to finish
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involution?
the attempt of the uterus to return to its pregnancy size
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boggy uterus
to be more losse than expected
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