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test 2 - test 2 READING(16 17 18 22 25 26 27 28 Postpartum...

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test 2 READING ( 16 , 17 , 18 , 22 , 25 , 26 , 27 , & 28 ): Postpartum: Chapters 17 , 18 , 22 , & 28 High risk Antepartum: Chapters 25 & 26 High risk Intrapartum: Chapters 16 & 27 Workbook: Postpartum: Chapters 17 , 18 , 22 , & 28 High risk Antepartum: Chapters 25 & 26 High risk Intrapartum: Chapters 16 & 27 Need to Review: CH 16: 1) Prostaglandin administration and nursing interventions A. Used for cervical ripening and dilation B. Done day before scheduled induction C. Given as intravaginal gel, intracervical gel, or time released insert D. Prostaglandin gel (dinoprostone [Prepidil]) 1. Dosage – 0.5 mg to cervix repeated in 6-12 hr.; 2.5 mg vaginally 2. Actions for hypertonic contractions – typically begins 1hr after gel application (higher incidence w/ vaginal) a. Place woman side lying b. O 2 @ 8-10 L/m per face mask c. Administer tocolytic – terbutaline or mag 3. No safe interval for oxytocin admin established a. Delay 6-12 hr. 4. Precautions/Comments a. Max dose = 1.5 mg/24 hr. b. Woman should remain recumbent for 15-30 min after application c. Increased effect in combined with other oxytocics d. Increases hypertensive effects of ephedra e. Use with caution in asthma, HTN, glaucoma, renal/hepatic dysfunction, or ischemic heart disease E. Vaginal insert (dinoprostone [Cervidil]) 1. Dosage – 10 mg in time-release vaginal insert 2. Actions for hypertonic contractions – occurs up to 9.5 hr after placement (higher incidence than gel) a. Remove insert b. Place woman side lying c. O 2 @ 8-10 L/m per face mask d. Administer tocolytic – terbutaline or mag 3. Oxytocin admin may begin 30-60 min after removal of insert 4. Precautions/Comments a. Remove after 12 hr or when active labor begins b. Adverse effects can be reduced within 15 minutes of insert removal c. Most expensive option F. Misoprostol (Cytotec) 1. Dosage – 25 mcg (1/4 of 100mcg non-scored tablet) q3-6 hr x 3 vaginally; 50 mcg hypertonic
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contractions 2. Actions for hypertonic contractions a. Place woman side lying b. O 2 @ 8-10 L/m per face mask c. Administer tocolytic – terbutaline or mag d. Higher dose/more frequent dosing excessive contractions 3. Oxytocin may begin 4 hr after last dose 4. Precautions/Comments a. Not FDA approved for this use b. Tablet is not scored – should be prepared by pharmacy for accuracy c. Contraindicated in previous cesarean or other uterine surgery G. Woman should lay flat for 15-20 min after admin to reduce leakage of gel H. Monitor FHR for 30 min I. Assess uterus for excessive contractions 2) Assessment associated with oxytocin administration – S/S of hypertonic uterine activity A. Contractions lasting longer than 90-120 seconds B. Contractions less than 2 min apart OR interval between contractions <30 sec. C. Uterine resting tone >20 mmHg (IUPC) D. Peak pressure >90 mmHg in 1 st stage of labor E. MVU >400 F. FHR pattern of late decelerations accompanying hypertonic uterine activity G. Nursing actions for hypertonic uterine activity 1. Reduce or stop oxytocin 2. Increase IV rate of non-additive infusion 3. Keep woman in lateral position 4. O 2 @ 8-10 L/m per face mask 5. Notify attendant 3) Contraindications to ECV A. Uterine malformations B. Previous cesarean with vertical incision
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