Labor, Delivery and Preterm Neonatal Drugs

Dena Evans, EdD(c), MPH, BSN, RN, CNEAssistant ProfessorDepartment of NursingThe University of North Carolina at Pembroke

Four • First (3 sub-phases)

Effacement and dilation Latent 0-4 cm Active 4-7 cm Transition 8-10 cm

• Second Pelvic

Complete dilation and delivery• Third

Placental separation and delivery• Fourth

Stabilization and bonding

Stronger, longer, more frequent contractions

Pain increases due to:• Cervical dilation• Effacement• Hypoxia of contracting myometrium• Perineal pressure

Physiologic Psychologic Social Culture Past experience with pain Anticipation Fear Anxiety

Ambulation Supportive positioning Touch/massage Hygiene and comfort measures Involving support persons Breathing and relaxation TENS Hypnosis Accupuncture Hydrotherapy Herbal supplements ---CAUTION

Sedative-tranquilizers Narcotic Agnonists Opioids with mixed narcotic

agonist/antagonist effects

• Given at onset of contractions to ↓ fetal exposure

meperidine (Demerol) fentanyl (Sublimaze) morphine sulfate nalbupine (Nubain) butorphanol (Stadol)

Local• Perineal Infiltration-before delivery or late

2nd stage• No effect on FHR or client’s vital signs

Regional-No loss of conciousness• Paracervical-1st stage-not widely used• Pudendal-2nd stage• Caudal-After labor well-established-not

widely used• Spinal-Immediately before delivery or late

2nd stage

RISKS: Hematoma, infection, trauma to sciatic nerve, rectal puncture.

Chloroprocaine Tetracaine Lidocaine Bupivacaine Ropivacaine

Hypotension, nerve injury, respiratory impairment (if given too high), headache.

Remember the spinal headache. Should lie flat after procedure.

Nursing: Make sure your client is well-hydrated. Placed in side-lying position for administration. Monitor BP every 1-2 minutes for the first 10 minutes after administration. Assess analgesia.

Cesarean Forceps delivery Postpartum for traumatic lacerations Removal of retained placenta

Umbilicus to toes (vaginal) Xyphoid process to toes (C-section)

Hypotension, nerve injury, headache (dura puncture), hematoma, impaired respirations (if given too high).

Clients should be well-hydrated Assess dizziness, tinnitus, metallic taste or

toxic response (indicates vein injection). Assess BP Mother on L side if hypotension occurs Assess level of analgesia After delivery-motor strength prior to

ambulation Assess for presence of bilateral analgesia

T12-S5 (entire pelvis)

Know

Aortocaval compression Wedge Left lateral position Inferior vena cava and aortic

compression Hypotension

Titrated based on uterine and fetal response

Need to establish adequate contraction pattern which promoted labor progress

Contractions every 2-3 minutes lasting 50-60 seconds/moderate intensity

Prevents uterine atony after delivery

Avoid Increased pain Compromised FHT patterns Must use infusion pump Half life is 1-9 minutes Onset: 3-5 minutes unless IV then

immediate Duration: 2-3 hours

Assess: consent, confirm gestation, collect baseline data, contraindications?

Diagnoses: Deficient knowledge Planning Interventions: Have agents and O2

available; Monitor I&O; Monitor VS, Monitor FHR; Monitor infusion, positioning

Evaluation: Effective labor progress, report changes in vital signs, FHR.

Not used during labor Given after delivery to prevent or

control postpartum hemorrhage and promote uterine involution (return to pre pregnancy size).

Ergonovine maleate (Ergotrate Maleate) and methylergonovine maleate (Methergine).

PO. IV not recommended unless emergency

IV: Assess hypertension Client already has HTN or PVD-should

not receive

Uterine cramping N/V Hypertension (IV administration) Chest pain, Dyspnea Sudden and severe headache

Ergotism Pain in arms, legs, lower back Numbness, cold hands and feet Blood hypercoagulation Hallucinations

Know Important: Notify MD if systolic BP

increases by 25mm/Hg or diastolic 20mm/Hg over baseline.

Teaching client that this may inhibit lactation.

Prevents the development of respiratory distress syndrome

Surfactant-keeps alveoli open during expiration

Also given in clients already diagnosed with RDS to prevent severity.

beractant Survanta calfactant Infasurg proactant alfa Curosurf **All products require intubation for

administration and specific positioning to ensure proper disbursement

Those adventitious breath sounds may be present after administration—unless respiratory distress—No suction x 2 hours

Reflux up ET tube

Infant• Dusky colored• Agitated• Bradycardic• O2 sats increases of more than 95%• Improved chest expansion• CO2 levels less than 30 mm/Hg

Know