NURS 3334 Study Guide - Final Guide: Lactation, Magnesium Sulfate, Calcium Gluconate
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Nurs3334 Final Exam Study Guide
Medications – When and why we use them
• Oxytocin (Pitocin)
o Oxytocin is released during breast feeding, causes contraction
o Oxytocin (Pitocin) side effect: uterine hyperstimulation, mild transient hypertension, water intoxication rare in
postpartum use
▪ Contraindications: none for postpartum use
o IV or IM
▪ If induced contraindicated
• Naloxone (narcan)
o Should be available in maternal and neonatal dosages
o Do not give to opioid dependent woman
• Butorphanole Tartrate (stadol)
o Butorphanol (stadol)***DO NOT GIVE STADOL OR NUBAINE TO OPIOD DEPENDENT WOMEN****
▪ Give at peak of contraction because the baby doesn't have oxygen anyways
o Causes immediate withdrawal
o Makes you feel drunk
• Magnesium sulfate
o For preterm contractions (muscle relaxant) and hypertension
o If labor has not stopped or ROM will try to maintain pregnancy as long as possible in hospital: Magnesium
Sulfate and glucocorticoid steroid therapy
o Relaxes smooth muscle – requires strict observation – pulmonary edema, respiratory distress, wheezing, loss of
dtr’s, urinary output under 30ml/hr, respiratory depression (less than 12/min)
▪ Check for magnesium toxicity
▪ Preterm labor to slow down delivery
▪ Relaxes smooth muscles
▪ High alert drugs to be cautious with
• Pulmonary edema, resp. distress, SOB, I&O, Foley
▪ Calcium gluconate or calcium chloride as antidote
• Calcium Gluconate
o Antidote for magnesium sulfate
o Should be at bedside – typically 1g given IV over 2 min.
o ** Seizure precautions for all women with severe preeclampsia:
▪ Bed sh/be low, side rails up, mat on floor
▪ Oxygen and suction set-up and available
▪ Plastic airway, emergency meds and equipment nearby
• Vitamin K
o Routine medication for newborns
o Absence of gut (sterile gut) bacterial flora + inability to produce vitamin K necessary for coagulation = low
prothrombin levels first few days of life (5-8 days)
▪ Don't want it to be worse than it already is
▪ Until they start eating, K prevents clotting disorders
o Therefore:
▪ Vitamin K to newborns prevents early clotting problems
• Vastus lateralis thigh muscle – 0.5 – 1.0 mg IM in birthing area or within one hour of delivery
• Betamethazone (celestone)
o Glucocorticoids Therapy – Steroid therapy
▪ ***Promotion of fetal lung maturity***
▪ Promotes release of enzymes that induce surfactant production/release
▪ INDICATION: Prevent/ reduce severity of RDS in preterm infants 24-34 weeks (NOT FDA approved
for this use)
▪ DOSAGE/ ROUTE: (Beta)- 12mg IM x2 doses 24 hrs. apart
• (Dexa)- 6mg x4 doses 12 hrs. apart
▪ ADVERSE REACTIONS: maternal infection, pulmonary edema, worsening diabetes/ hypertension
• NURSING CONSIDERATIONS: Not given if maternal infection, controversial in PPROM,
assess glucose/ B.P.
• Rho gam
o Concentrated immunoglobulins
o Prevents production of anti-Rh antibodies in Rh- women
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o ***WOMEN PREVIOUSLY SENSITIZED TO RH FACTOR RECEIVE NO RhoGAM – checked prenatally at
28 weeks!
o Administered Postpartum IM to MOTHER within 72 hours of delivery if infant Rh +
• Ephedrine
o To prevent hypotension during spinal anesthesia
Hormones
• Estrogen
o Enhances myometrial activity and vasodilation
o Promotes secretion of prolactin
o Increases maternal respiratory receptor sensitivity to CO2
o Softens cervical collagen tissue
o Increases sensitivity of uterus to progesterone late in pregnancy
o Uterus growth 1st trimester via hyperplasia (cell growth stim by estrogen)
o Ovulation ceases related to high levels of estrogen and progesterone
o MUCOUS PLUG- estrogen stimulates the glandular tissue which increases cell numbers and creates the mucous
plug
o Estrogen stimulates growth of mammary ductal tissue and progesterone stimulates lobes, lobules, aveoli
o Epistaxis and nasal congestion is common from increased estrogen
o Hyperemia of mouth/ gum tissue (related to increased estrogen) contributes to gingivitis, bleeding gums – dental
care is important!
o Melanocyte –stimulating hormone elevated r/t impact of progesterone and estrogen may cause:
▪ “Chlasma” (brown patches) and/or
▪ “Linea nigra” (pigmented line on abdomen)
o Hyperemesis gravidarum hormonal: sensitivity to high levels of hCG and estrogen
o “Estrogen/progesterone” pills: reduce risk of ovarian and endometrial cancer
• Prolactin
o Ovary does not respond to (FSH) when prolactin high so ovulation is suppressed
o 15-20 alveolar glands contain acinar cells manufacture milk when stim. by prolactin
▪ When signaled by oxytocin cells around ducts contract and eject milk.
▪ Suckling stimulates milk ejection
o Infant suckling signals Hypothalamus to:
▪ Stimulate Anterior Pituitary and Prolactin is released (milk made)
▪ Stimulate Posterior Pituitary and Oxytocin is secreted (cause “let-down” or milk ejection reflex)
• Progesterone
o Progestin birth control only for breast-feeding moms / less impact on milk production
o Relaxes smooth muscle in GI, urinary systems
o Decreases myometrial activity
o Inhibits secretion of hormone prolactin
o Suppresses maternal immunologic responses
o Decreases maternal respiratory center sensitivity to CO2
o Works to keep you pregnant, won’t contract too early Decreased Peripheral Vascular Resistance
▪ Caused by progesterone, increased prostaglandin synthesis
▪ Allows blood pressure to remain stable (except for supine hypotension)
Terms to know and apply
• Leopold’s maneuver
o Maneuvers 1-3 stand beside woman
o 1st maneuver:
▪ Palpate uterine fundus
o 2nd maneuver:
▪ One hand steady, palpate on other side of fetus / then rpt. with opposite side
o 3rd maneuver:
▪ Palpate suprapubic area
o 4th maneuver: Face feet
▪ Slide hands down either side of fetus
• Stages and phases of labor
o First Stage: Onset ctx. to 10cm dilation/100% effacement
▪ TOTAL AVG DURATION: 8-10 hrs. primip / 6-7 parous
▪ 1) Latent Phase- 0-3cm dilation / ctx. mild, irreg. Q 3-30min/ up to 30-40 sec.
• Longest of three phases, may pass unnoticed
• Averages 8.6 h. primip / 5.3 h. parous
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▪ 2) Active Phase- 4-7cm dilation / ctx. mod.- strong Q 2-5min/ last 40-60 sec.
• Contractions increase in frequency & intensity, discomfort greatly increases
• Averages 4.6 h. primip / 2.4 h. parous
▪ 3) Transition Phase- 8-10 cm dilation / ctx. strong Q 1-2min / last 60-90 sec.
• Short, intense phase, very strong ctx./ often “urge to push” at end
• Averages 3.6 h. in primip / few minutes to sev. hours in parous
o Second Stage: Full dilation to birth of fetus
▪ Primiparas: 30 min to 3 hrs. /
▪ Parous: 5 minutes to 30 minutes
▪ Prominence of pain fr. perineal stretching, distension, pressure
▪ Frequently strong “urge to push” (Ferguson reflex)
▪ Voluntary maternal pushing efforts needed with uterine contractions
▪ “Crowning” of fetal head signifies birth imminent
o Third Stage: Birth of fetus until placenta delivered
▪ Usually 5-10 minutes after birth
▪ “Retained” if over 30 minutes after
▪ GENTLE traction & pressure on fundus may be needed
▪ Accompanied by uterine ctx. to expel placenta
▪ SIGNS: Gush of blood, Cord lengthens, Fundus rises***
• Fetal (shiny) side usually presents first “Shiny Schultze”
• Maternal side presents “Dirty Duncan”
o Fourth Stage: About 1- 4 hours after delivery
▪ Blood loss + Redistribution of placental circulation = moderate drop in blood pressure, tachycardia
▪ Hemorrhage risk
▪ Pain
▪ Perineal trauma
▪ Bladder hypotonia
▪ Thirst / Hunger
▪ Uncontrollable shaking “chill”
• Cold stress (heat loss)
o Post term infant and preterm infant more at risk
o Can contribute to jaundice
o ****Infants who are cold or hot require intervention***** Cold Stress = higher oxygen demands = acidosis
o Prevention:
▪ Neutral Thermal Environment (NTE) on admission (radiant warmer with servo)
▪ First bath under warmer or quickly then re-warmed
▪ Skin-to-skin or wrapped
▪ Hat on head while in crib
▪ Monitor:
• Dry
• Room temp warm
• Away from cold surfaces
• Out of drafts
o Restoration:
▪ Correct obvious causes
▪ Resume skin-to-skin, reassess
▪ Intervene with blankets or warmer (below 97.7F ax.)
▪ Re-check temp
o Monitoring/ Evaluation:
▪ Temperature assessment at least q/shift
▪ ***Report inability to maintain temp without external causes
o ***NOTE: Low-birth weight infants (LBW) - extra blankets to maintain temp ***
• Fetal heart rate monitoring (FHR)
o Baseline FHR
▪ Rounded to 5bpm, measured over 2 min during a 10 min period
▪ Normal 110-160 BPM
▪ Bradycardia = less than 110 for at least 10 minutes
• If + accels and mod var may be normal in term infant. If decreased var, -accels, and + decels
may be hypoxia
▪ Tachycardia = FHR more than 160 for at least 10 minutes
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Document Summary
Medications when and why we use them: oxytocin (pitocin, oxytocin is released during breast feeding, causes contraction, oxytocin (pitocin) side effect: uterine hyperstimulation, mild transient hypertension, water intoxication rare in postpartum use, contraindications: none for postpartum use. If labor has not stopped or rom will try to maintain pregnancy as long as possible in hospital: magnesium. ***promotion of fetal lung maturity**: promotes release of enzymes that induce surfactant production/release. 1: ***women previously sensitized to rh factor receive no rhogam checked prenatally at. 28 weeks: administered postpartum im to mother within 72 hours of delivery if infant rh , ephedrine, to prevent hypotension during spinal anesthesia. Linea nigra (pigmented line on abdomen: hyperemesis gravidarum hormonal: sensitivity to high levels of hcg and estrogen. Inhibits secretion of hormone prolactin: caused by progesterone, increased prostaglandin synthesis, allows blood pressure to remain stable (except for supine hypotension)
