Postpartum and Newborn Drugs Chapter 55 Postpartum and Newborn Drugs Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drugs Used Postpartum Prevent uterine atony and postpartum hemorrhage Relieve pain from uterine contractions, perineal wounds, and hemorrhoids Enhance or suppress lactation Promote bowel function Enhance immunity Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drugs Used Postpartum (Cont.) Nonpharmacologic agents Pain relief for uterine contractions NSAIDs Opioids Pain relief for perineal wounds and hemorrhoids Topical and local agents Witch hazel and dibucaine ointment Side effects and adverse reactions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Perineal Wounds and Hemorrhoids 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.

Drugs Used Postpartum (Cont.) Lactation suppression Nonpharmacologic measures more commonly used than pharmacologic agents Chlorotrianisene (Tace), Deladumone OB, or bromocriptine mesylate (Parlodel) Pyrioxidine (vitamin B6) for 5 days Ingesting sage tea approximately every 6 hours Using 3 to 4 mL of alcohol tincture every 6 hours via the mucous membranes Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drugs Used Postpartum (Cont.) Promotion of bowel function Nonpharmacologic measures Pharmacologic measures Stool softeners Laxative stimulants Antiflatulents Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Laxatives Assessment Nursing diagnosis Planning Nursing interventions Patient teaching Cultural considerations Evaluations Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Understanding Rh Isoimmunization Immunizations Enhancement of immunity Understanding Rh Isoimmunization Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Immunizations  Maternal blood is assessed for the D antibody at the initial prenatal laboratory evaluation and at 26 to 28 gestational weeks. Human D immune globulin (RhoGAM, RhO[D] immune globulin) is routinely administered to women with maternal/fetal blood mixing. During the postpartum period, D immune globulin should be administered within 72 hours. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Immunizations (Cont.) Rh sensitization process can be prevented through the administration of RhO(D) immune globulin (RhoGAM) to unsensitized Rh-negative patients after each actual or potential exposure to Rh-positive blood. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Rubella Vaccination Congenital rubella syndrome There is no treatment for maternal or congenital rubella infection. The goals are immunization and prevention of rubella in patients of childbearing age. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Immunizations 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.

Drugs Administered to Newborn Immediately after Birth Erythromycin ophthalmic ointment Vitamin K Site for Giving an Intramuscular Injection to a Newborn Shortly after Birth. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Immunization During the Newborn Period Before Discharge Hepatitis B virus (HBV) HBV transmission occurs vertically, primarily at the time of delivery. Recombinant hepatitis B (Engerix-B, Recombivax HB) If appropriate, administer hepatitis B immune globulin (HBIG) injections. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Drugs Administered to Newborn Immediately after Delivery 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.

Practice Question #1 Before administration of Rh immune globulin D, what is an appropriate nursing intervention? To monitor blood pressure To check for a signed informed consent To administer an analgesic To confirm that patient is Rh-positive Answer: B Rationale: Obtain patient’s written consent before administration. Some agencies require a refusal form if the drug is declined. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 The nurse knows that correct instillation of the eye ointment used for newborn eye prophylaxis is directly onto the cornea. into the inner canthus of the eye. into the lower conjunctival sac. under the upper eyelid. Answer: C Rationale: Administer ophthalmic ointment (ribbon of ointment about 1 cm long) from inner canthus to outer canthus in lower conjunctival sac of each eye. Do not touch eye with applicator. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 A patient experiences postpartum hemorrhoids. The nurse anticipates the initial treatment to include which of the following? Warm sitz baths Rectal suppositories Frequent enemas Narcotic analgesia Answer: A Rationale: A nonpharmacologic treatment such as warm sitz baths would most likely be used for this patient. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #4 Which is the most common treatment approach for lactation suppression? Chlortrianisene (Tace) Deladumone OB Bromocriptine mesylate (Parlodel) Wearing a supportive bra 24 hours a day for 10 to 14 days Answer: D Rationale: In the past, lactation was commonly controlled through drug therapy with one of the three agents listed in the options. Presently, nonpharmacologic measures such as wearing a supportive bra 24/7 for 10 to 14 days, breast binding, and axillary ice packs are recommended for lactation suppression. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #5 When administering Rho(D) immune globulin, the nurse will administer the medication by mouth. administer the drug within 30 days of delivery. instruct the patient to avoid live virus vaccines for 1 month after administration. have epinephrine available to treat anaphylaxis. Answer: D Rationale: Epinephrine is used to treat anaphylaxis associated with administration of this drug. Rho(D) immune globulin is normally administered in the deltoid muscle within 72 hours after delivery, but if more than 72 hours has passed, it should be administered as soon as possible up to 28 days; a lesser degree of protection may result. Patients receiving Rho(D) should avoid live virus vaccines for 3 months after administration. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.