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Transcript
Chapter 53
Female Reproductive Cycle I:
Pregnancy and Preterm Labor Drugs
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
1
Female Anatomy
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Male Anatomy
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Hypothalamic-Pituitary-Gonadal
Feedback Loops
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Female Reproductive Cycle


Physiology of pregnancy
Therapeutic drug and herbal use in
pregnancy



Iron
Folic acid
Multiple vitamins
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Drugs for Minor Discomforts of
Pregnancy

Discomforts associated with pregnancy

Nausea and vomiting
• The FDA has approved one drug for morning sickness,
doxylamine succinate and pyridoxine hydrocholoride
(Diclegis).
• Ginger may be used.

Heartburn: sucralfate (Carafate)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Drugs for Minor Discomforts of
Pregnancy (Cont.)

Discomforts associated with pregnancy


Constipation: Metamucil, docusate sodium
(Colace)
Pain:
• Acetaminophen: Most commonly ingested
nonprescription drug during pregnancy
• Aspirin: Not recommended during pregnancy
• Ibuprofen: Classified as a pregnancy category C drug
(which changes to category D if used in the third
trimester). If taken late in pregnancy, it may cause
premature closure of the ductus arteriosus.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Drugs Taken During Pregnancy

Antidepressant drugs


Selective serotonin reuptake inhibitors (SSRIs)
Tricyclics
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Nursing Process: Antepartum Drugs




Assessment
Nursing diagnoses
Planning
Nursing interventions



Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Drugs That Decrease Uterine Muscle
Contractility


Preterm labor
Tocolytic therapy


Beta2-adrenergic receptor agonists
• Terbutaline
Calcium antagonists
• Magnesium sulfate
• Calcium channel blockers
• Nifedine (Procardia)
• Indomethacin (Indocin) prostaglandin inhibitors
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Beta-Sympathomimetic Drugs

Terbutaline




Stimulating beta2-receptors on uterine smooth
muscle
The frequency and intensity of uterine contractions
decrease as the muscle relaxes.
Preterm labor
Adverse effects
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Nursing Process: Terbutaline




Assessment
Nursing diagnosis
Planning
Nursing interventions



Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Magnesium Sulfate



Calcium antagonist and central nervous
depressant
Relaxes the smooth muscle of the uterus
through calcium displacement
Used more commonly as a tocolytic
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Nursing Interventions During
Tocolytic Therapy






Maternal and fetal assessment
Assess deep tendon reflexes (DTR).
Assess pain and uterine contractions.
Monitor serum magnesium levels as ordered
(therapeutic level is 4 to 7 mg/dL).
Have calcium gluconate (1 g given IV over 3
minutes) available as an antidote.
Observe newborn for 24 to 48 hours for
magnesium effects if drug was given to
mother before the delivery.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Corticosteroid Therapy in Preterm
Labor





Betamethasone (Celestone)
Dexamethasone
Accelerates lung maturation and lung
surfactant development in the fetus in utero
Decreases the incidence and severity of
respiratory distress syndrome (RDS)
Increases survival of preterm infants
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Nursing Process: Betamethasone
(Celestone)




Assessment
Nursing diagnosis
Planning
Nursing interventions


Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Drugs for Gestational Hypertension

Gestational hypertension


Preeclampsia



Most common serious complication of pregnancy
Gestational hypertension with proteinuria
A severe sequela of preeclampsia is known as
HELLP syndrome (defined by Hemolysis, Elevated
Liver enzymes, and Low Platelet count).
Eclampsia

New-onset grand mal seizures in a patient with
preeclampsia
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Drugs for Gestational Hypertension
(Cont.)

Preeclampsia and eclampsia


Preeclampsia: Delivery of infant and placenta is
the only cure.
Eclampsia (maternal seizure): Delivery is
generally postponed for 1 to 3 hours if fetal status
allows.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Treatment of Preeclampsia






Methyldopa (Aldomet)
Hydralazine (Apresoline)
Labetalol (Trandate)
Prazosin (Minipress)
Nifedipine (Procardia)
Clonidine (Catapres)
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Nursing Process: Gestational
Hypertension




Assessment
Nursing diagnoses
Planning
Nursing interventions



Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Practice Question #1
The nurse is aware that folic acid deficiency in
pregnancy may result in any of the following
except
A.
B.
C.
D.
placenta previa.
spontaneous abortion.
neural tube defects.
small-for-gestational-age (SGA) infant.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Practice Question #2
An RN on orientation is working with a patient
with gestational hypertension. Which action by
the orienting nurse necessitates intervention by
the supervising RN? When the orienting nurse
A. places the patient in the right lateral recumbent
position
B. assesses deep tendon reflexes because the patient
is on magnesium sulfate
C. uses a electronic BP cuff because the patient is on
hydralazine
D. maintains continuous fetal monitoring
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Practice Question #3
The nurse knows that which herbal remedy
should not be given to the pregnant patient
because it stimulates the uterus?
A.
B.
C.
D.
Kava kava
St. John’s wort
Sage
Ginseng
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Practice Question #4
A pregnant patient who is prescribed a liquid iron
supplement complains that her teeth have become
discolored. What is the proper response by the
nurse?
A.
B.
C.
D.
“This is a normal reaction to liquid iron supplementation. You
should plan to visit your dentist for regular dental cleanings.”
“You should stop taking the liquid iron supplement because
tooth discoloration indicates a serious health issue.”
“This is a normal reaction to liquid iron supplementation. It will
go away after you give birth and stop taking the extra iron.”
“This is a normal reaction to liquid iron supplementation. You
can minimize it by drinking the supplement through a straw.”
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Practice Question #5
The nurse identifies which as a clinical
manifestation of maternal magnesium sulfate
toxicity?
A. Muscle rigidity
B. Dry skin
C. Pallor
D. Nasal congestion
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Practice Question #6
A patient has a serum magnesium level of
10 mg/dL. The nurse anticipates
administration of
A.
B.
C.
D.
magnesium citrate.
calcium gluconate.
potassium chloride.
sodium chloride.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26