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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