Nursing Interventions (for Methergine accidentally given via IV)

1. Mon. BP 2. Mon. vaginal bleeding (amount and character of discharge) 3. Discontinue if signs of toxicity occur (HPN, seizure, headache, palpitations, chest pain, nausea and vomiting, MI if combined with vasoconstrictors) 4. Notify physician Why suction the mouth first before nose? Answer: nasal suctioning can stimulate reflex inhalation (of materials/secretion) which could lead to aspiration

Generic Name: Nalbuphine HCl

Brand Name: Nubain

Classification: Opiod agonist-antagonist Dose: 10-20 mg/kg IM, IV SQ q 3-4 hr Indications: moderate to severe pain Effect to the mother: analgesia Effect to the baby: repiratory distress Nursing considerations: 1. Assess for emotional instability or hx of opioid abuse 2. Taper dosage when discontinuing the therapy 3. Keep opioid antagonist and facilities available in case of respi depression

Immunoglobulin that crosses the placenta: Answer: Immunoglobulin G - provides 75-80 % total immunity - present in all bodily fluids provides protection for the fetus against virus, bacteria

Erythroblastosis fetalis - develops in an unborn infant when the mother and baby have different blood types/ rh factor. The mother produces substances called antibodies that attack the developing baby's red blood cells. - most common form is ABO incompatibility - severe form is called Rh incompatibility Si/sx: Before baby is born: - Fast heart rate. - Enlarged organs, such as the heart, liver, or spleen. - Swelling of the whole body. After baby is born: - Anemia - Enlarged organs ( heart, liver, or spleen) - Jaundice (may be present at birth or appears within 24 hours after birth) - Small red or brown spots, or purple patches on the skin - Swelling of the whole body - Trouble breathing Prevention The most severe form of this disease, Rh incompatibility, can be prevented if the mother takes a medicine called RhoGAM at certain times during and after pregnancy.

Difference between opioid and non-opioid analgesic:  Opioid - relieve pain by acting directly on the central nervous system - they bind to opioid receptors in many regions of the nervous system - moderate to severe pain - controlled substance (risk for physical and psychological dependence, tolerance)  Non-opioid - work more directly on injured body tissues - have analgesic, antipyretic, and anti-inflammatory actions - do not bind to opioid receptors and are not classified under the Controlled Substances - milder forms of the painkiller - do not produce tolerance or physical dependence and are not associated with abuse or addiction

Alternative Names Hemolytic disease of the newborn How is erythroblastosis fetalis treated? Before baby is born: 1. Blood transfusions: baby may need to have blood transfusions while still in the womb. These may be given through the umbilical cord. 2. Preterm delivery After baby is born: 1. Phototherapy: uses special bright lights to help break down and get rid of the bilirubin in the baby's body 2. Immune globulin: Immune globulin given intravenous (IV) is also called IVIG. This medicine helps to keep the baby's RBCs from being damaged by antibodies made by the mother's body.

Adult circulation sequence 1. Non-oxygenated blood enters the right atrium via the inferior and superior vena cava. 2. Increase level of blood in the right atrium causes the tricuspid valve to open and drain the blood to the right ventricle. 3. Pressure of blood in the right ventricle causes the pulmonic valve to open and non-oxygenated blood is directed to the pulmonary artery then to the lungs. 4. Exchange of gases occurs in the lungs. Highly oxygenated blood is returned to the heart via the pulmonary vein to the left atrium. 5. From the left atrium the pressure of the oxygenated blood causes the mitral valve to open and drain the oxygenated blood to the left ventricle. 6. Left ventricle then pumps the oxygenated blood that opens the aortic valve. Blood is then directed to the ascending and descending aorta to be distributed in the systemic circulation. Fetal Circulation Sequence 1. Exchange of gases occurs in the placenta. Oxygenated blood is carried by the umbilical vein towards the fetal heart.

2. The ductus venosus directs part of the blood flow from the umbilical vein away from the fetal liver (filtration of the blood by the liver is unnecessary during the fetal life) and directly to the inferior vena cava. 3. Blood from the ductus venosus enters to the inferior vena cava. Increase levels of oxygenated blood flows into the right atrium. 4. In adults, the increase pressure of the right atrium causes the tricuspid valve to open thus, draining the blood into the right ventricle. However, in fetal circulation most of the blood in the right atrium is directed by the foramen ovale (opening between the two atria) to the left atrium. 5. The blood then flows to the left atrium to the left ventricle going to the aorta. Majority of the blood in the ascending aorta goes to the brain, heart, head and upper body. 6. The portion of the blood that drained into the right ventricle passes to the pulmonary artery. 7. As blood enters the pulmonary artery (carries blood to the lungs), an opening called ductus arteriosus connects the pulmonary artery and the descending aorta. Hence, most of the blood will bypass the non-functioning fetal lungs and will be distributed to the different parts of the body. A small portion of the oxygenated blood that enters the lungs remains there for fetal lung maturity. 8. The umbilical arteries then carry the non-oxygenated blood away from the heart to the placenta for oxygenation.