RLE IV-1 Leader: Agbay, Danica Bianca Members: Abesamis, Melberte Abuda, Rachelle Agreda, Angelini Aguda, Eunice

Heincy Agunat, Jeanne Albaran, Camille Albarida, Betha Fe Alberto, Arjay Franz Joseph Alcanices, Benedict Allado, Arvin

ANTEPARTUM
It is the time between conception and the onset of labor Often used to describe the period during which a woman is pregnant

REPRODUCTIVE SYSTEM
Danica Bianca F. Agbay

Reproductive System
Consists of external structures visible from the pubis to the perineum and internal structures located in the pelvic cavity.
Develop and mature in response to estrogen and progesterone. This process starts in fetal life and continues to puberty and the childbearing years.

Female Reproductive System: on the outside

Mons pubis
Mons veneris Fatty pad that lies over the anterior surface of the symphysis pubis

Labia Majora

Two rounded folds of fatty tissue covered with skin that extend downward and backward from the mons pubis Protect the structure lying between them.

Labia minora
Soft folds of the skin within the labia majora that converge near the anus, forming the fourchette Fused to form prepuce and frenulum

Clitoris

Located underneath the prepuce With erectile tissue with numerous nerve endings

Vaginal vestibule
Enclosed by the labia minora that contains: o opening to the urethra o Skenes gland o Vagina, hymen o Bartholins gland

Perineum
Area between the fourchette and the anus

Female Reproductive System: on the inside

 produce eggs receive the sperms provide the site for fertilization implantation of the growing embryo and development of the fetus produces hormones that control the various stages of ovulation and maintenance of pregnancy

Vagina
The secretions are acidic which is not conducive to the sperms as semen is alkaline.

Passage for menstrual flow Female organ of copulation Part of the birth canal for vaginal childbirth

Uterus
Upper end- corpus Lower end- cervix, which provides a protective entrance for the body of the uterus serves for reception, implantation, retention and nutrition of the fertilized ovum and for cyclic menstruation.

 Function of the cervical mucous: To lubricate the vaginal canal To act as bacteriostatic agent To provide an alkaline environment to shelter deposited sperm from the acidic vagina.

 Uterine wall: Endometrium- several glands. (innermost) Myometrium- smooth muscles (midlayer) Peritoneum- connective tissue. The inner surface of the uterus provides a site for the implantation of the embryo.

Fallopian tube/oviduct
Arises from the ovaries of each side to the uterus supported by the broad ligaments

Provide transport for the ovum from the ovary to the uterus Provide site for fertilization of the egg by the sperm

Ovaries
For ovulation and hormone production. produce eggs, one at a time, every month. The eggs are produced by the germinal epithelial cells of the ovary. Primary source of the estrogen and progesterone.

Bony pelvis
Protection of the pelvic structures Accommodation of the growing fetus during pregnancy Anchorage of the pelvic support structures.

 False Pelvis -upper portion above the pelvic brim or inlet. -level of ischial spine

True Pelvis -lower curved bony canal -level of the ischial tuberosities and the pubic arch inlet, cavity, and outlet

Breasts
Conical and symmetrically placed on side of the chest Nipple Areola Provide nourishment and protective maternal antibodies to infants through the lactation process Source of pleasurable sexual sensation

Female hormones
Estrogen Progesterone Prostaglandins

Estrogen
Associated with characteristics contributing to the femaleness Controls the development of the female secondary sex characteristics Assists in the maturation of the ovarian follicles and cause the endometrial mucosa and proliferative following menstruation Amount is greatest during proliferative phase of the menstrual cycle Causes the uterus to increase in size and weight

Progesterone
Hormone of pregnancy Secreted by the corpus luteum Amount is greatest during secretory phase Decreases uterine motility and contractility caused by the estrogen Causes the uterine endometrium to further increase its supply of glycogen, arterial blood, secretory glands, amino acids and water.

Prostaglandin
Oxygenated fatty acids produced by the cellls of the endometrium Increases during follicular maturation dependent on gonadotropin

Neurohumoral basis of FRC

Hypothamlamus GnRH anterior pituitary gland FSH and LH lutenizing the theca and granulosa cells of the Ovarian follicle ruptured follicle Inc Estrogen Enhance the development of the follicle

Dec Est and Inc Prog Ovulation

Menstruation
Periodic uterine bleeding that begins approximately 14 days after ovulation. Endometrial Menstrual phase Proliferative phase Secretory phase Ischemic phase 28 days 5 days 50 ml

Endometrial Cycle
Menstrual phase o shedding of the functional two thirds of the endometrium
Proliferative phase o period of rapid growth lasting from about the fifth day to the time of ovulation

 Secretory phase o from the day of ovulation to about 3 days before the next menstrual period. o after ovuation, larger amount of progesterone are produced. Ischemic phase o if fertilization and implantation dont occur o functional endometrium and necrosis develops.

During the menstrual cycle:

Estradiol

FSH and LH

14 days after the beginning of menstrual period

LH
Released from ovary

Mature egg

progesterone
Prepares the lining of the uterus for implantation of the fertilized egg

Fallopian tube

blastocyst

blastocyst endometrium
6 to 10 days of fertilization

implantation

No implantation/not fertilized by the sperm

HCG
Prolongs secretion of progesterone and estrogen from the ovary

Automatically stops progesterone and estrogen

menstrual flow

placenta

50 ml

By Jeanne U. Agunat, 4-1

I. INITIAL PRENATAL ASSESSMENT

Duration of Due Date (AOG & EDB)

Last Menstrual Period

It refers to the first day of your last period before conception occurred.

Expected Date of Birth (EDB)

It is an archaic term for the estimated date a baby might be born. It is determined based on the first day of a woman's last menstruation (LMP).

NAEGELES RULE (Expected date of birth)

EDB = (1st day of LMP) + 7 days 3 months + 1 year LMP: 10th of July, 2006
Days 10 +7 17 Months Year 7 -3 4 EDB: 17th of April, 2007

06 +1 07

PARIKHS FORMULA
EDB = LMP + 9 months + (Duration of previous cycles - 21 days)

LMP 8th of May, 2007 Duration of previous hypothetically 32-day cycles menstrual cycle
EDB = 8 May 2007 + 9 months = 8 February 2008 = 8 February 2008 + 32 days = 11 March 2008 = 11 March 2008 21 days = 19th of February, 2008

In modern practice, a gestation calculator or wheel permits the caregiver to calculate the EDB even more quickly.

Age of Gestation (AOG)

It is the time measured from the first day of the woman's last menstrual cycle to the current date. It is measured in weeks. A normal pregnancy can range from 38 to 42 weeks.

TINAMBAN STYLE
LMP: September 28, 2008 Assessment date: April 21, 2009

LMP: September: 28 7 = 21 days left after LMP

September: October: November: December: January: 31 February: March: April: 21 31 30 31 28 31 21, 2009

= 224 divided by 7 = *32 weeks divided by 4 = 8 months

32 weeks AOG

II. FACTORS THAT MAY INFLUENCE DUE DATE

A. Uterine Assessment

Physical Examination First 10-12 weeks of pregnancy Uterine size is compatible to menstrual history May be the single most important clinical method for dating pregnancy

II. FACTORS THAT MAY INFLUENCE DUE DATE A. Uterine Assessment

Fundal Height Centimeter (cm) tape measure MCDONALDS METHOD (estimation of the duration of the pregnancy)
No. of cm x 8/7 = weeks of gestation No. of cm x 2/7 = duration of pregnancy in months

II. FACTORS THAT MAY INFLUENCE DUE DATE

A. Assessment of Fetal Developmen

Quickening

Fetal Heart Rate

Nearing 20 weeks AOG 16-22 weeks AOG

Doppler: 8-11 weeks AOG Fetoscope: 16-19/20 weeks AOG

II. FACTORS THAT MAY INFLUENCE DUE DATE B. Assessment of Fetal Development
Ultrasound

Crown-to-Rump
1st trimester Gestational sac Fetal heart activity Fetal breathing movement

Biparietal diameter (BPD)

5-6 weeks AOG 6-7 weeks AOG 10-11 weeks AOG

II. FACTORS THAT MAY INFLUENCE DUE DATE

B. Assessment of Pelvic Adequacy (Clinical Pelvimetry) Pelvic Inlet

Diagonal Conjugate at least 11.5 cm

Obstetric Conjugate 10 cm or more

II. FACTORS THAT MAY INFLUENCE DUE DATE

B. Assessment of Pelvic Adequacy (Clinical Pelvimetry) Pelvic Outlet

Anteroposterior Diameter Transverse Diameter 9.5-11.5 cm (intertuberous) 8-10 cm

Leopold's Maneuver

III. SUBSEQUENT PRENATAL ASSESSMENT

III. SUBSEQUENT PRENATAL ASSESSMENT

IV. PREGNANCY NUTRITION

Maternal Weight Gain

Optimum Ranges of Weight Gain (IOM, 1992)

Underweight

28-40 lbs

12.5-18 kg

Normal-weight

25-35 lbs

11.5-16 kg

Overweight

15-25 lbs

7-11.5 kg

Obese

> 15 lbs

> 7.0 kg

Maternal Weight Gain

Ideal Pattern of Weight Gain (IOM, 1990) 1st Trimester 3.5-5 lbs 1.6-2.3 kg

2nd Trimester
3rd Trimester

1 lb per week

0.5 kg

Nutritional Concerns

VS

Maternal Physiologic Changes

Arvin Jan K. Allado

Maternal Physiologic Changes

Reproductive System
-Uterus -Cervix -Ovaries -Vagina

Reproductive System

Uterus
Before pregnancy End of Pregnancy -small, semi-solid, pear-shaped organ -Dimensions = 28x Dimensions= 7.5x 24x 21cm -Weight = 1100g 5x 2.5cm -Capacity= more Weight= 60g than 5000mL Capacity= 10mL

Reproductive System-Uterus
Limited increase in cell number during the pregnancy Enlarging of the uterus, developing placenta and growing fetus inc. blood flow to the uterus. 1/6 of the maternal blood flow is within the vascular system of the uterus.

Reproductive System-Uterus
Inc. fibrous tissue between muscle bands inc. strength and elasticity of the muscle wall.

Reproductive System
Cervix
Estrogen stimulates glandular tissue of the cervix, which increases in cell number and becomes hyperactive. Endocervical glands secrete thick and sticky mucus mucus plug = protects the endocervical canal from the ascent of microorganisms into the uterus. Expelled as the cervical dilatation begins.

Reproductive System-Cervix
Increased cervical vascularity causes

Goodells sign
(softening of the cervix) and Chadwicks sign (bluish discoloration)

Reproductive System

Ovaries
Ovaries stopped producing ova during pregnancy Corpus luteum continues to produce hormones until week6-8. Progesterone is secreted until 7th week placenta assumes the role to support the endometrium.

Reproductive System
Vagina
Estrogen thickens the vaginal mucosa, loosening its connective tissues and increases vaginal secretions. Its secretions are thick, white and acidic prevents bacterial infection but favors the growth of yeast organism susceptibility to monilial infections

Breasts

Enlarged and become more nodular as glands increase in size and number in preparation for lactation
Nipples become more erectile; areolas darken Montgomerys follicles enlarge; striae may develop

Respiratory System
Volume of air breath increases each minute from 30% to 40%. Progesterone decreases airway resistance which permits increase of oxygen consumptions of 15% 20%. Abdominal breathing thoracic breathing As uterus enlarges, it presses upward and elevates the diaphragm

Cardiovascular
Blood volume increases starting in the 1st trimester, increases rapidly in the 2nd and slows in the 3rd and peaks near term at about 40% to 45% above non-pregnant levels. inc. BV = inc. in erythrocytes + plasma CO begins to inc. early in pregnancy & remains elevated throughout gestation Pulse = inc. of 10-15 bpm Leukocyte production = inc. slightly to an average of 5000 to 12000/mm3

Cardiovascular
Pressure to the femoral and pelvic vessels=Stasis of blood in the lower extremities = Postural hypotension. Stasis of blood in LE dependent edema Varicosities in the veins in the legs, vulva and rectum (hemorrhoids)

Cardiovascular
When lying on supine position, uterus puts pressure on the vena cava and aorta supine hypotensive syndrome (vena caval syndrome or aortocaval compression)
S/Sx= dizziness, pallor and clamminess. Plasma increases up to 50% Erythrocytes increases up to 30% May lead to physiologic anemia of pregnancy or pseudoanemia

Gastrointestinal System
Nausea and vomiting are common = elevated human chorionic gonadotropin levels + changed carbohydrate metabolism. Increased secretion of saliva ptyalism (if excessive) Elevated progesterone levels smooth muscle relaxation delayed gastric emptying + decreased peristalsis

Urinary Tract
1st trimester=Urinary frequency Urinary frequency decreases during 2nd trimester; reappears at 3rd trimester GFR rises as much as 50% in the second trimester and remains elevated until birth ; renal tubular reabsorption also increases.

Urinary Tract
Glycosuria may be present to pregnant women because of the inability of the body to absorb all the glucose filtered by the glomeruli. Glycosuria may be normal or may indicate gestational diabetes (GDM) and further testing should be done.

PHYSIOLOGICAL CHANGES IN PREGNANCY

Arjay Franz Joseph Alejandro Alberto, UST-SN

DERMATOLOGIC CHANGES

MUSCULOSKELETAL CHANGES

EYES

METABOLIC CHANGES

ENDOCRINE CHANGES
INCREASE Thyroid and parathyroid1, 2Thyroxinebinding globulin (TBG) concentrations T4 and T3 Parathyroid hormone DECREASE Serum calcium levels

TSH production is stimulated, great increase may indicate iodine deficiency or subclinical hypothyroidism

SIGNS OF PREGNANCY
AFJAAlberto, UST-SN

SIGNS OF PREGNANCY

PRESUMPTIVE (SUBJECTIVE) PROBABLE (OBJECTIVE) POSITIVE (DIAGNOSTIC)

PRESUMPTIVE SIGNS

PRESUMPTIVE SIGNS

PRESUMPTIVE SIGNS
QUICKENING

PROBABLE SIGNS

PROBABLE SIGNS

PROBABLE SIGNS

Pregnancy Tests Ballotement

POSITIVE SIGNS

POSITIVE SIGNS
Fetal Movement

POSITIVE SIGNS

Conception 1st Month 2nd Month

5th Month 6th Month 7th Month

3rd Month
4th Month

8th Month
6th Month

sperm fertilizes the ovum

 first body segments Heart, blood circulation and digestive tract take shape less than a 1/ 4

o Rapid o Heart -- pump blood o developed limb buds o Facial features and major divisions of the brain are discernible o Ears -- skin folds o Tiny bones and muscles

o Embryo becomes fetus o Heartbeat is discernible o more human shape o lower body develops o Week 12 first movements begin

o Maturation of musculoskeletal system o Nervous system -control o Blood vessels o grasp o Legs kick actively o All organs begin to mature and grow o 7 oz o FHT discernible o Insulin production

Vernix Lanugo Eyebrows, eyelashes and head hair develop schedule of sleeping, sucking and kicking

Skeleton develops rapidly as bone forming cells increase activity Respiratory movements begin Fetus weighs 1 lb, 10oz

breathe, swallow, regulate temperature

Surfactant forms oEyes begin to open and close 2/3 the size it will be at birth

Brown fat deposits 15-17 in Begins storing iron, calcium and phosphorus

uterus is occupied by the baby, thus restricting its activity Material antibodies

Weight loss

Polyphagia Polyuria Polydipsia

WHITES CLASSIFICATION OF DIABETES MELLITUS

DR. PRISCILLA WHITE

Class A Diabetes (Type 1), Insulin Dependent

Absolute insulin deficiency
Glucose tolerance test slightly abnormal

Fetal survival is high

Class C and E (Type 2), NIDDM

Gestational Diabetes

Predisposing factors:
Family history of DM

Other factors:

Maternal Risks:

Hydramnios Pre-eclampsia-eclampsia Ketoacidosis Spontaneous abortion Gestational hypertension Pre-term labor Retinopathy

Fetal-Neonatal Risks
Congenital defects Sacral agenesis Large for gestational age/ Macrosomia Intrauterine growth restriction Respiratory distress syndrome IUFD Delayed lung maturity Ketoacidosis Neonatal hyperbilirubinemia Hypoglycemia Polycythemia Learning disabilities Childhood obesity and Type 2 DM later in life

DIAGNOSTIC TESTS
Betha Fe Albarida

Non-stress Test
A nonstress test (NST) measures the fetal heart rate in response to the fetus' movements.

Test results of the NST may be:

Reactive (normal) - two or more accelerations of FHR of 15 beats/min lasting 15 seconds or more in 20 min period. Nonreactive - there is no change in the fetal heart rate when the fetus moves. <15 betas/min or lasting <15 seconds throughout the testing period. Unsatisfactory test - the data cannot be interpreted

Biophysical Profile
Test that measures the health of your baby during pregnancy. A BPP test may include a nonstress test with electronic fetal heart monitoring and a fetal ultrasound. The BPP is most common in the third trimester.

Indications:
Risk for placental insufficiency or fetal compromise Intrauterine growth retardation- IUGR Maternal diabetes, GDM Renal disease Preeclampsia, HTN Sickle cell disease Rh sensitization Nonreactive NST

Fetal Variables
FETAL VARIABLE NORMAL BEHAVIOR (SCORE = 2) Intermittent multiple episodes of more than 30 sec duration, within 30min time frame. ABNORMAL BEHAVIOR (SCORE = 0) Continues breathing without cessation Absence of breathing

Fetal Breathing Movements

Body or limbs movements

Four discrete body movements excluding mouthing movements

<4 body/limb movements in 30 mins

Fetal Tone

Active extension with rapid return of flexion of fetal limbs and brisk repositioning.

Low velocity movement only.

FETAL VARIABLE

NORMAL BEHAVIOR (SCORE = 2)

ABNORMAL BEHAVIOR (SCORE = 0)

Fetal Heart Rate

Acceleration associated with maternal palpation of fetal movement for 20 min

Fetal movement and accelerations not coupled

Amniotic Fluid Evaluation

At least one pocket >3cm with no umbilical cord.

No cord free pocket >2cm or elements of subjectively reduced amniotic fluid definite.

Ultrasound

First Trimester
Confirms pregnancy Confirm viability Determine gestational age Rule out ectopic pregnancy Detect multiple gestation Visualization during chronic villus sampling Detect maternal abnormalities such as bicornuate uterus, ovarian cysts, fibroids

Second Trimester
Establish or confirm dates Confirm viability Detect polyhydramnios, oligohydramnios Detect congenital anomalies Detect intrauterine growth restriction (IUGR) Confirm placenta placement Visualization during amniocentesis

Third Trimester
Confirm gestational age Detect microsomia Determine fetal position Detect placenta previa or abruptio placenta Biophysical profile Amniotic fluid volume assessment Doppler flow studies Detect placental maturity

Amniocentesis
Amniocentesis is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. Possible after 14 week of pregnancy

2nd Trimester Down syndrome (trisomy 21) Trisomy 18 and neural tube defects (NTDs) Chromosome analysis Fetal hemolytic disease (Rh-

3rd Trimester Fetal lung maturity-L/S ratio

 If neural tube defects or Rh incompatibility are a concern, an amniocentesis will be performed.

Indications for use:

Genetic concerns Fetal Maturity

Chorionic Villus Sampling

Chorionic villus sampling (CVS) is a prenatal test in which a sample of chorionic villi is removed from the placenta for testing Done between the 10th and 12th weeks of pregnancy

 The test is a way of detecting genetic disorders. The sample is used to study the DNA , chromosomes, and chemical markers of disease in the developing baby.

Chorionic villus sampling does not detect neural tube defects.

You may consider chorionic villus sampling if:

You had abnormal results from a prenatal screening test. You had a chromosomal abnormality in a previous pregnancy.

You're age 35 or older.

You have a family history of a specific genetic disorder, or you or your partner is a known carrier of a genetic disorder.

Oral Glucose Tolerance Test

An OGTT can be used to diagnose prediabetes and diabetes. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes).

For the 50-gram oral glucose tolerance test that is used to screen for gestational diabetes:

1 hour: less than 140 mg/dL

For the 100-gram oral glucose tolerance test:

Fasting: less than 95 mg/dL 1 hour: less than 180 mg/dL 2 hours: less than 155 mg/dL 3 hours: less than 140 mg/dL

Oral Glucose Challenge Test

A glucose challenge test (GCT), also called a one hour glucose screening test, 50 gram glucose challenge, or gestational glucose screening test, is a test which measures the blood sugar levels of pregnant women.

Nursing Care Plans

Benedict Alcanices

Assessment
Objective: BP: 240/110 RR: 28/min CR: 123/min T: 37.5 (+) Edema (grade 2) Distended neck veins Bibasilar crackles BLF

Nursing Diagnosis

Decreased cardiac output related to decreased venous return.

Rationale
- Inadequate

blood is pumped by the heart to meet the metabolic demands of the body.

Goals and Objectives

Short term: After 3 hours of nursing interventions, the patient will display hemodynamic stability in blood pressure within her normal range. Long term: After 3 days of nursing interventions, the patient will demonstrate activities that reduce the workload of the heart stress.

Nursing Interventions

Rationale

Keep client on bed or chair rest in position Decreases oxygen consumption and risk of comfort. In congestive state, semiof decompensation. fowlers position is preferred.

Administer high flow oxygen via nasal canula Administer blood/ fluid replacement, antibiotics, diuretics, inotropic drugs as indicated.

To increase oxygen available for cardiac function/ tissue perfusion To determine therapeutic, adverse or toxic effects to therapy.

Nursing Interventions

Rationale

Assess urine output hourly; weigh daily, noting total fluid balance
Decrease stimuli; provide quiet environment Elevate legs when in sitting position

To allow for timely alterations in therapeutic regimen

To promote adequate rest

To enhance venous return

- Encourage changing positions slowly, dangling legs before standing

To reduce risk for orthostatic hypotension

Evaluation
Short term: After 3 hours of nursing interventions, the patient display hemodynamic stability in blood pressure within her normal range. Long term: After 3 days of nursing interventions, the patient demonstrates activities that reduce the workload of the heart stress.

Assessment
BP = 240/110, RR=28/min PR=123/min (+) distended neck veins (+) Nasal flaring

NURSING DIAGNOSIS

Ineffective tissue perfusion cardiopulmonary related to vasoconstriction of blood vessels secondary to preeclampsia

RATIONALE

It is resulted from a systemic vasoconstriction in the body caused by pre eclampsia. Vasoconstriction is the decrease in the diameter of the blood vessels which occur in diseases like pregnancy-induced hypertension. Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level.

OBJECTIVES
Short term: Client will demonstrate adequate perfusion, as evidenced by stable vital signs, palpable pulses, and alert and oriented, absence of seizure episodes, balanced intake and output, decrease in presence of edema and good fetal status evaluation within a week. Long term: Client will demonstrate readiness during the postpartal period in monitoring ones health and involving oneself to dietary restrictions and medical follow up checkups and intervention.

NURSING INTERVENTIONS Monitor vital signs, palpate peripheral pulses and note capillary refill, assess urinary output, weigh client daily and evaluate changes in mentation.
Place client on left recumbent position. Monitor maternal well- being periodically

RATIONALE Indicators of adequacy of systemic perfusion, fluid/ blood, needs, and developing complications.

This is to avoid uterine pressure on the vena cava and prevent supine hypotension syndrome. Convulsions are evident in Eclampsia so it should be watched out and monitored.

Ensure safety by putting the side rails always up and monitor client for tonicclonic convulsions. Provide quiet and restful environment Maintain activity restrictions

Helps reduce stimulation and promotes relaxation Reduces physical stress and tension

NURSING INTERVENTIONS

RATIONALE

Administer oxygen as prescribed Administer Hydralazine as ordered

To ensure supply of oxygen to both the mother and the fetus. Hydralazine is used to treat high blood pressure. It works by relaxing the blood vessels so that blood can flow more easily through the body. Magnesium sulfate prevents or controls seizures in pre-eclampsia brought about by vasospasm secondary to vasoconstriction of blood vessels These restrictions can help manage fluid retention and with associated hypertensive response, which decrease cardiac workload.

Administer Magnesium sulfate as ordered.

Promote diet with low protein, low cholesterol and fat

EVALUATION
Short term: Clients blood pressure is below 140/90mmHg, urine output of above 30ml/hour, fetal heart rate is between 120-160 beats per min, absence of seizure episodes, decrease in presence of edema. Long term: Client verbalizes plans upon discharge, participates during lecturediscussion sessions, and demonstrates willingness to perform monitoring measures.

MEDICATIONS

FeSO4
Elevates the serum iron concentration, which then helps to form Hgb or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron.

Nursing consideration
1. Confirm that patient does have iron deficiency anemia before treatment. 2. Give drugs with meals ( avoiding milk, eggs, coffee and tea) if GI discomfort is severe; slowly increase to build up tolerance. 3. Administer liquid preparations in water or juice to mask the taste and prevent staining of teeth, have the patient drink solution with a straw. 4. Warn patient that stool may be dark or green. 5. Arrange for periodic monitoring of Hct and Hgb levels

Contraindications Side-effects Sulfite allergy, - CNS toxicity, acidosis, coma hemochromatosis, and death with overdose. hemosiderosis, hemolytic - GI upset, anorexia, nausea, anemias. Use cautiously with vomiting, constipation, normal iron balance, peptic diarrhea, dark stools, ulcer, regional enteritis, temporary staining of the ulcerative colitis. teeth.

MgSO4
Magnesium sulfate inhibits convulsion by acting at the myoneural junction to prevent release of acetylcholine and to decrease the motor and plate potential. It inhibits the contraction of the uterus by directly acting on the myometrial cells and enhancing uterine blood flow.

Nursing intervention
1. Observe constantly when given IV. Check BP and pulse q15 min or more often if indicated. 2. Monitor respiratory rate closely. Report immediately if rate falls below 12. 3. Test patellar reflex before repeated parenteral dose. Depression of reflexes is a useful index of early magnesium toxicity. 4. Check urinary output especially in patients with impaired kidney function.

CONTRAINDICATIONS Magnesium Sulfate injection is contraindicated to patients with heart block or myocardial damage.

SIDE EFFECTS an allergic reaction breathing difficulties; poor reflexes; confusion, extreme tiredness or weakness; low body temperature; severe headache; fainting; rash or flushing;

Dexamethasone
Dexamethasone is a synthetic glucocorticoid which decreases inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability. It suppresses normal immune response.

NURSING INTERVENTION
1. Establish baseline of VS, IO, weight. 2. Monitor BP during stabilization phase 3. Assess patient to take anti-inflammatory on schedule and dont stop abruptly, expect a slight weight gain and avoid alcohol and caffeine. 4. May be beneficial for HELPSS

CONTRAINDICATION
Hypersensitivity; active untreated infections; ophthalmic use in viral, fungal disease of the eye.

SIDE EFFECTS
Convulsion Headache Increased ICP Hyperglycemia

Hydralazine
Hydralazine is a vasodilator that works by relaxing the muscles in the blood vessels to help them dilate (widen). This lowers blood pressure and allows blood to flow more easily through the veins and arteries.

Nursing intervention
1. Monitor the clients blood pressure and pulse frequently during initial dosage adjustment and periodically throughout therapy. Report significant changes to the physician. 2. Monitor frequency of prescription refills to determine adherence. 3. Prior to and periodically during prolonged therapy the following lab values should be monitored: CBC, electrolytes, LE Cell Prep and ANA titer. 4. The nurse must be aware that Hydralazine may cause a positive direct Coombs test result. 5. IM or IV route should be used only when the drug cannot be given orally. 6. Hydralazine may be administered concurrently with diuretics or beta blockers to permit lower doses and minimize side effects. 7. It is important to remind the patient to keep using Hydralazine as directed, even if he or she feels well. High blood blood pressure often has no symptoms, so you may not know when your blood pressure is high.

CONTRAINDICATION
Hypersensitivity Severe tachycardia Dissecting aortic aneurysm Heart failure with high cardiac output Cor pulmonale Myocardial insufficiency due to mechanical obstruction Coronary artery diseas Idiopathic SLE Patients with recent MI

SIDE EFFECTS
Dizziness Drowsiness Headache Tachycardia Angina Arrhythmias Edema Orthostatic hypotension Diarrhea Nausea and vomiting Rashes Sodium retention Arthralgias Arthritis Peripheral neuropathy

Nicardipine
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction.

NURSING INTERVENTION
1. Advise patient to avoid grapefruit and grapefruit juice during therapy.

2. Caution patient to change positions slowly to minimize orthostatic hypotension. 3. May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known. 4. Instruct patient to avoid concurrent use of alcohol or OTC medications, especially cold preparations, without consulting health care professional. 5. Advise patient to notify health care professional if irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness nausea, constipation, or hypotension occurs or if headache is severe or persistent. 6. Caution patient to wear protective clothing and to use sunscreen to prevent photosensitivity reactions. 7. Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks.

CONTRAINDICATION Hypersensitivity; Sick sinus syndrome; 2nd- or 3rd-degree AV block (unless an artificial pacemaker is in place); BP <90mmHg; Advanced aortic stenosis. Use Cautiously in: Severe hepatic impairment (dose reduction recommended); Geri: Geriatric patients (dose reduction/slower IV infusion rates recommended foremost agents; increased risk of hypotension); Severe renal impairment (dose reduction may be necessary); History of serious ventricular arrhythmias or CHF; OB, Lactation, Pedi: Pregnancy, lactation, or children (safety not established).

SIDE EFFECTS increased heart rate due to the drop in blood pressure. Other side effects include swelling of the feet(edema), dizziness, headaches, flushing, palpitations, and nausea.

Furosemide
Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

Nursing intervention
1. Administer with food or milk to prevent GI upset. 2. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds. 3. Give early in the day so that increased urination will not disturb sleep. 4. Avoid IV use if oral use is at all possible. 5. Do not mix parenteral solution with highly acidic solutions with pH below 3.5. 6. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. 7. Discard diluted solution after 24 hr. 8. Refrigerate oral solution. 9. Measure and record weight to monitor fluid changes. 10. Arrange to monitor serum electrolytes, hydration, liver function.

11. Arrange for potassium-rich diet or supplemental potassium as needed.

CONTRAINDICATION Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.

SIDE EFFECTS - Dizziness, - vertigo, - paresthesias, - weakness, - headache, - drowsiness, - fatigue, - blurred vision, - tinnitus, - Orthostatic hypotension, - volume depletion, - cardiac arrhythmias