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Cadeesia Douglas

Mrs. Lapolla

Maternal Database

NURS 3731 Clinical

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During this clinical my focus of care was directed towards a mother who had a cesarean

section the previous day. Throughout my time with her I asked questions about her family,

nutritional habits, support team, relationships and more. I learned from her that this baby was

unplanned although she was not using any type of birth control. She explained to me that most of

her prenatal care consisted of high-risk appointments due to the size of the baby. He was born at

36 weeks and was considered preterm weighing in at 5lbs 11 ounces. After being born his

bilirubin levels were extremely high and he was transported to Akron Children’s Hospital. This

was putting some stress on the mother and she was concerned for her baby but knew he was in

good hands. She was eager to get out of the hospital so she could go see him in Akron. During

my assessment I looked at her incision which was covered with the silver dressing. She stated

that she was not in any pain and her vitals were normal. She had no signs of infection which is a

risk factor following a cesarean section. Because of the 5 other children I would assure the

mother had all the necessities she needed to care for the new child and had a good support team

to help her out when needed. I would also ask questions concerning how the other children felt

about the new baby to be sure the family dynamic was suitable, and the environment was safe.

The discharge planning that I would include for this mother was care for her abdominal incision

such as how to look for signs of infection and cleansing. Infant education on feedings, safe sleep,

safety, vaccinations and how to care for a preterm baby. I would also teach her about the signs

and symptoms of postpartum depression so she would know when she needed to get help and

contact her physician.

During this clinical I feel like I had a good amount of confidence after I finally got into

the room. The mother I cared for was nice and welcoming and did not make me feel

uncomfortable in any was which is a relief. She had a good understanding about raising babies
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since she has many other children and was doing well even with being separated from her new

baby. One thing I learned is the importance of Celestone to preterm babies. This medication aids

in the development of the lungs for babies who are born early to assure they can breathe properly

and survive outside the womb. It is taken by the mother and is passed to the baby in utero across

the placenta. Overall, this was a wonderful clinical experience and I wish the best to the new

mother and baby!

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Maternal Database Meds

Celestone (betamethasone)
- Classification: corticosteroid
- Action: Acceleration of fetal lung maturity and reduces incidence of intraventricular
hemorrhage and neonatal death in the preterm infant. Suggested for women who have
preterm rupture of membranes.
- Dosage: Usual route is an IM injection in 2 doses of 12 mg, 24 hours apart.
- Side effects: pulmonary edema, increased hunger, increased anxiety, increased blood
pressure. Also, hypoglycemia for the baby and hyperglycemia for the mother.
- Nursing responsibility/teaching: Nurse should be aware to check the blood sugar
more often in a diabetic mom, assess lung sounds, and teach the mother to let the
nurse know when she is experiencing chest pain, heaviness, or dyspnea. The nurse
should also be aware to keep an eye on mom’s WBC and platelet levels as those may
rise temporarily for 72 hours.
- Contraindications: Contraindicated in patients with systemic fungal infections. Drug
is pregnancy Class C. Get physicians approval before breastfeeding. Use in caution in
patients with osteoporosis, diverticulitis, or peptic ulcer disease.
Percocet (oxycodone hydrochloride–acetaminophen) 
- Classification: Opioid 
- Action: Oxycodone binds with opioid receptors in the CNS, altering perception of and
emotional response to pain. Acetaminophen is thought to produce analgesia by inhibiting
prostaglandin and other substances that sensitize pain receptors. The combination reduces
pain more effectively than acetaminophen alone. 
- Dosage: Moderate-moderately serve pain: Oxycodone 2.5 to 10 mg
and acetaminophen 325 mg PO every 6 hours as needed for pain. Acute pain: 2 tablets
PO every 12 hours 
- Side effects: paresthesia, hypoesthesia, dizziness, drowsiness, fatigue, headache,
dysphoria, insomnia, peripheral edema, circulatory depression, hypotension, shock, dry
mouth, constipation, dyspepsia, nausea, vomiting, diarrhea, dysuria, hemolytic
anemia, neutropenia, pancytopenia, thrombocytopenia, increased liver enzyme levels,
cough, apnea, respiratory arrest, respiratory depression, pruritus, erythema, erythematous
dermatitis, excoriation, rash, flushing, anaphylaxis 
- Nursing Responsibilities/implications: Monitor circulatory and respiratory status closely.
Monitor vistal signs and sedation level. Keep opioid antagonist (naloxone) and
resuscitation equipment available. The lowest effective dosage should be prescribed for
the shortest period of time. Assess patients identified as potential abusers; drug should be
prescribed with extreme care. All patients using opioids should be routinely monitored
for signs and symptoms of misuse, abuse, and addiction. Watch for signs and symptoms
of serotonin syndrome. Monitor patient for signs and symptoms of adrenal insufficiency.
Monitor patients for orthostatic hypotension. Monitor patients with acute abdominal
conditions closely. Drug may mask signs and symptoms in these patients. 
- Contraindications: Contraindicated in patients hypersensitive to components of drug and
in those with significant respiratory depression, acute or severe bronchial asthma,
hypercarbia. Use cautiously in acute abdominal conditions because this drug may obscure
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diagnostic signs or markedly increase respiratory depression or CSF pressure. Use

cautiously in hypotensive patients, elderly or debilitated patients, and in those with severe
renal or hepatic impairment, hypothyroidism, urethral stricture, or Addison disease. 

Toradol (Ketorolac)
- Classification: NSAID
- Action: Used short term, for less than 5 days, for moderate to severe acute pain usually
after surgery or after giving birth. Works by blocking the production of prostaglandins
that cause pain, fever and inflammation.
-  Dosage: Transfer to oral: 20 mg PO as first dose for patients who received 60 mg IM or
30 mg IV as a single dose or 30 mg multiple-dose, followed by 10 mg every four to six
hours; do not exceed 40 mg/24 hr.
-  Side effects: Life-threatening: GI ulceration, Post-op bleeding, acute renal failure, liver
failure. Common: headache, heartburn, upset stomach, nausea, vomiting, diarrhea,
dizziness, drowsiness 
- Nursing Responsibilities/implications: Know patient history and allergies. Report any
signs of itching, swelling in ankles, sore throat, and easy bruising
-  Contraindications: Contraindicated in patients with active peptic ulcer disease. Should
not be given to patients that experienced asthma or allergic type reactions after taking
aspirin or other NSAIDs. Should not be given to patients already taking aspirin or other
NSAIDs

 Feosol, Slow FE, Iron (Ferrous Sulfate)

- Classification: Supplement (iron), Hematinic 
-  Action: Prevents/treats iron deficiency anemia in pregnant women. Anemia can be
linked to behavioral and cognitive impairments and low birth weight in newborns as well
as premature deliveries.
-  Dosage: Tablet - Pregnant: 27 mg/day. Lactating: 10 mg/day. Infants 0-6 mths: 0.27
mg/day
Best time to administer is between meals.
- Side effects: Common: Black/tar like stools, nausea, vomiting, constipation, diarrhea, GI
upset. Major/Life Threatening: GI perforation, GI hemorrhage, GI obstruction (all 3 are
rare)
- Nursing Responsibilities/implications:Avoid giving with antacids or milk; may be given
with juice or water. Should be given on empty stomach/between meals but can be given
with food if GI upset occurs. Teach about possible discoloration of urine and stools. Do
not crush or chew.
- Contraindications: hemolytic anemia, ulcerative colitis, hemochromatosis, peptic
ulceration, regional enteritis

Pitocin (Oxytocin)
- Classification: Oxytocic 
- Action: Pregnant: can induce or stimulate labor (contracts uterus) Labor: strengthens
contractions. Postpartum: reduces bleeding after delivery of placenta. Other: can be used
to complete an abortion 
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-  Dosage: Pregnant: dilute by adding 30 units to 500 ml of lactated ringer solution. 0.5-1
milliunit/min through IV. Increase by 1-2 milliunits/min every 30-60 min until regular
labor contractions are happening. The full 9-10 milliunits/min are rarely used. Labor:
dilute by adding 10-40 units to 1,000 ml lactated ringer solution through IV to produce
labor contractions. Postpartum: After delivery of placenta, 10 units IV may be given to
control bleeding. Abortion: add 10 units to 500 ml normal saline. IV infusion of 10 units
at 10-20 milliunits/min.
- Side effects: Maternal- Common: nausea, vomiting. Major/Life-Threatening:
subarachnoid hemorrhage, seizure, pelvic hematoma, arrhythmias, uterine rupture,
abruptio placentae, postpartum hemorrhage, anaphylaxis, uterine hypertonicity. Fetus-
Major/Life Threatening: neonatal jaundice, retinal hemorrhage, seizures, brain damage,
arrhythmias
- Nursing Responsibilities/implications: Pt must be under continuous observation. Teach
pt to report any difficulty speaking, swelling, blurred vision, wheezing and itching.
Discontinue infusion immediately if fetal distress or uterine hyperactivity
occurs. Monitor intake and output (water intoxication can lead to fluid overload,
seizures, or coma). Monitor uterine contractions, intrauterine pressure, HR/BP (mother
and baby) at least every 15 min.
- Contraindications: fetal distress, when vaginal delivery is not advised, cervical cancer,
overdistended uterus, ute
 
Duramorph (morphine hydrochloride)
- Classification: opioid analgesics
- Action: Binds with opioid receptors in the central nervous system, altering perception and
emotional response to pain 
- Dosage: 5 mg by epidural catheter, then if pain is not relived in 1 hour give
supplementary doses of 1-2 mg 
- Side effects: Common: somnolence, constipation, nausea, vomiting, dizziness,
diaphoresis, headache, anxiety. Major/life threatening: cardiac arrest, shock, bradycardia,
respiratory arrest, respiratory depression.
- Nursing Responsibilities/implications: Assess patients’ risk of addiction. Monitor for
respiratory depression. Monitor vital signs. If respirations drop below 12
breaths/minutes, withhold dose, and notify prescriber. Do not exceed epidural dose of
10mg/24 hours. Teaching: Encourage patient to report all medications being taken and
caution patient about ambulation on their own
- Contraindications: GI obstruction, Elderly, or debilitated patients. Cautions in those with
head injury, seizures and increased ICP.

Ancef (cefazolin)
- Classification: cephalosporin
- Action: Cephalosporins exert bactericidal activity by interfering with the later stages of
bacterial cell wall synthesis.
- Dosage: The recommended dosing range in adults is 250 mg to 1500 mg given every 2 to
4 hours.
- Side effects: nausea, vomiting, diarrhea, chest pain, swelling of the face, difficulty
breathing.
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- Nursing implications/teaching: monitor for signs of pseudomembranous colitis, teach

signs and symptoms of pseudomembranous colitis.
- Contraindications: caution in patients with seizure disorders.

Prenatal Vitamin
- Classification: vitamin
- Action: promote health and fetal wellbeing during pregnancy
- Dosage: 1-27 mg, oral 1 tablet a day.
- Nursing implications/teaching: Best taken on an empty stomach, take every day.

Reference

Lowdermilk, D. L., Perry, S. E., Cashion, K., Alden, K. R., & Olshansky, E. F. (2020).
Maternity & women’s health care. St. Louis, MO: Elsevier.