Ob Nursing Drug Cards Essay

Custom Student Mr. Teacher ENG 1001-04 2 April 2016

Ob Nursing Drug Cards

Generic Name: meperidineBrand Name(s): Demerol| Pregnancy Category: C| Route of Administration: IM, SUBCUT| Drug Category: opioids analgesic| Indication: labor analgesia| Normal Dosage:Labor analgesia Adult: 50-100 mg given when contractions regularly spaced repeat q1-3h prn| Side Effects:CNS: drowsiness, dizziness, confusion, HA, sedation, euphoria, increased intracranial pressure, seizures, respiratory depression, anaphylaxis|

Nursing Considerations/Teachings/Interventions:
Nursing Consideration: pt should remain recumbent for 1hr after IM/SUBCUT route, inject into large muscle mass May cause fatal reaction: MAOI’s, carbazine
Tx for Overdose: Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids vasopressors Assess-
•Pain: location, type, character. Give before pain is extreme and reassess 60 mins after dose.•I & O •CNS Cx: dizziness, drowsiness, decreased LOC, euphoria, pupil reaction Respiratory dysfunction

Safety measures: •night-light; •call bell within reach
Teach: •Report any CNS Cx or allergic reactions. •If drowsiness occurs call for assistance; •Make position Cx slowly d/t orthostatic hypotension

Nursing Considerations/Teachings/Interventions:
Nursing Consideration: pt should remain recumbent for 1hr after IM/SUBCUT route, inject into large muscle mass May cause fatal reaction: MAOI’s, carbazine
Tx for Overdose: Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids vasopressors Assess-
•Pain: location, type, character. Give before pain is extreme and reassess 60 mins after dose.•I & O •CNS Cx: dizziness, drowsiness, decreased LOC, euphoria, pupil reaction Respiratory dysfunction

Safety measures: •night-light; •call bell within reach
Teach: •Report any CNS Cx or allergic reactions. •If drowsiness occurs call for assistance; •Make position Cx slowly d/t orthostatic hypotension

Generic Name: fentaNYLBrand Name(s): ABSTRAL, Actiq, Fentora, Onsolis, RAN-Fentanyl| Pregnancy Category: C| Drug Category:Opioid analgesic| Indication: •Control moderate to severe pain •Premedication or adjunct to anesthesia (conscious sedation or regional)| Route of Administration:IV, Transmucosal, Buccal, nasal spray, SL spray| Nursing Considerations/Teachings/Interventions:Nursing Considerations: •Notify prescriber if Resp rate <10 bpm •Assess for CNS Cx •Allergic reactions: rash, urticarialEvaluate: •Therapuetic responseTeach: •TCDB, post-op •Safety measures – siderails, night-light, call bell within reach •Possible CNS Cx|

Common Side Effects: •CNS: dizziness, delirium •CV: blurred vision •GI: N & V, constipation, urinary retention •INTEG: rash, diaphoresis •MS: muscle rigidity| Life Threatening Side Effects: •CV: Bradycardia, CVA •RESP: respiratory depression, MI, larngospasm| Normal Dosage: (Adult)Anesthetic • IV 25-100 mcg q 2-3 min prnAnesthesia supplement •IM/IV 2-20- mcg/kg •IV Infusion 0.025-0.25 mcg/kg/min Induction and maintenance •IV bolus 5-40 mcg/kgPreoperatively • IM/IV 0.05 – 0.1 mg q30-60 min before surgeryPostoperatively • IM/IV 0.05-0.1 mg q1-2h prnSedation/analgesia • IV 0.5-1 mcg/kg/dose, may repeat after 30-60min | Ped’s Dosage:Anesthetic Induction and maintenance: 2-12 yrs IV 2-3 mcg/kg Sedation/analgesia:1-12 yrsIV Bolus 1-2 mcg/kg/dose, may repeat q30-60mins; continue IV 1-5 mcg/kg/hr after IV bolus doseSedation (neonate)IV bolus 0.5mg-3 mcg/kg/dose with continuous IV 0.5mg-2 mcg/kg/hr after IV bolus.|

Generic Name: ibuprofenBrand Name(s): Advil, Midol, Motrin| Pregnancy Category: B 3rd trimester- Cat D| Route:PO, IV| Drug Category: NSAID, non-opioid analgesic| Indication: inflammation, analgesia, antipyretic| Nursing Considerations: Adm with food, milk or antiacid to decrease GI symptoms; if N&V occur or persis, notify perscriber Assess- •Pain: note type, duration, lacoation, intensity with ROM 1 hr after adm•Infection: may mask symptoms; fever: temp before and 1 hr after admEvaluate- Therapeutic response: decreased pain, stiffness in joints; decreased swelling in joints; ability to move more easily; reduction in fever or menstrual cramping Teach- •Therapuetic effects may take up to 1 mo •Report blurred vision, ringing,
roaring in ears (may indicate toxicity); eye and hearing tests for long-term therapy Alert: Nephrotoxicity: report Cx in urinary pattern, increased weight, edema, increased pain in joints, fever, blood in urine Alert: Avoid alcohol, NSAIDs, salicylates; bleeding may occur| Side Effects:Headache, CV, thrombotic events, MI, stroke, anorexia, hepatitis, GI bleeding, ulceration, necrotizing enterocolitis, GI perforation, Nephrotoxicity, Blood dyscrasias, nectrotizing fascitis, anaphylaxis, Stevens-Johnson syndrome|

Normal Dosage:
Self Tx of minor aches/pains — Adult/adolescent: PO (available OTC) 200mg 44-6hr, may increase to 400mg q4-6hr if needed, max 1200mg/day Analgesic–Adult: PO 200-400 mg q4-6hr, max 3.2g/day; OTC use max 1200mg/day Child: PO 4-10mg/kg/dose q6-8hr Moderate to severe pain (hospitalized)(caldolor)– Adult: IV 400-800mg q6hr as an adjunct to opioid-agonist therapy Antipyretic– Child 6mo-12yr: PO 5mg/kg (temp. <102.5◦ F or 39.2◦C), 10mg/mg (>102.5◦), may repeat q6-8hr, max 40 mg/kg/day Dysmenorrhea–Adult: PO 400mg q4hr, max 1200mg/day

Anti-inflammatory– Adult: PO 400-800mg tid-qid, max 3.2mg/day Child: PO 30-40mg/kg/day in 3-4 divided doses, max 50mg/kg/day Patent ductus arteriosus (PDA) (NeoProfen)
Premature neonate <32wk premature gestation who weighs 500-1500g: IV 10mg/kg initially, then, if needed, 2 doses of 5mg/kg at 24hr intervals; if oliguria occurs, hold dose Normal Dosage:
Self Tx of minor aches/pains — Adult/adolescent: PO (available OTC) 200mg 44-6hr, may increase to 400mg q4-6hr if needed, max 1200mg/day Analgesic–Adult: PO 200-400 mg q4-6hr, max 3.2g/day; OTC use max 1200mg/day Child: PO 4-10mg/kg/dose q6-8hr Moderate to severe pain (hospitalized)(caldolor)– Adult: IV 400-800mg q6hr as an adjunct to opioid-agonist therapy Antipyretic– Child 6mo-12yr: PO 5mg/kg (temp. <102.5◦ F or 39.2◦C), 10mg/mg (>102.5◦), may repeat q6-8hr, max 40 mg/kg/day Dysmenorrhea–Adult: PO 400mg q4hr, max 1200mg/day

Anti-inflammatory– Adult: PO 400-800mg tid-qid, max 3.2mg/day Child: PO 30-40mg/kg/day in 3-4 divided doses, max 50mg/kg/day Patent ductus
arteriosus (PDA) (NeoProfen)
Premature neonate <32wk premature gestation who weighs 500-1500g: IV 10mg/kg initially, then, if needed, 2 doses of 5mg/kg at 24hr intervals; if oliguria occurs, hold dose

Generic Name: naproxenBrand Name(s): Naprosyn| Pregnancy Category: C3rd trimester Cat-D| Route of Administration: PO| Normal Dosage:Anti-inflammatory/analgesic/antidysmenorrhealAdult: PO 250-500mg bid, max 1250mg/day; DEL REL 375-500mg bidChild> 2yr: PO 5-7mg/kg q8-12hrOTC DOSE:Adult: PO 750mg, then 250mg q8-12hr or 440mg then 220mg q12hr; max 660 mg/24hr taken < 10 days| Drug Category: NSAID, non-opioid analgesic| Indication: Tx inflammation & pain| Side Effects:BBW – preoperative pain in CABG surgeryBBW – MI, GI bleed, strokeDizziness, Drowsiness, N&V, MI, stroke, hepatitis, GI ulceration, GI bleed, GI perforation, Nephrotoxicity: dysuria, hematuria, oliguria, azotemia, blood dyscrasias, anaphylaxis|

Nursing Considerations: Adm with food to decrease GI upset
Assess: •Pain: frequency, characteristics, intensity; relief before and 1-2hr after adm •Arthritis: ROM, pain, swelling before and 1-2hr after use •Fever: before, 1hr after adm •Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, H/H, LDH, blood glucose, WBC, platelets, CCr before Tx, periodically thereafter during long-term therapy •BBW: GI status: ulceration, bleeding, perforation; may be fatal; obtain stool guaiac •BBW: cardiac status: CV thrombotic events, MI, stroke; may be fatal; not to be used in CABG. Alert: aspirin hypersensitivity or nasal polyps, increased risk of hypersensitivity Evaluate: Therapeutic response: decreased pain, stiffness, swelling in joints; ability to move more easily Teach: •Use sunscreen, photosensitivity. •Report blurred vision, ringing or roaring in ears (may indicate toxicity) •Report Cx in urine pattern, weight increase, edema (face, lower extremities), increased joint pain, fever, blood in urine (indicates nephrotoxicity); black stools, flulike symptoms•Therapeutic effects may take up to 1 mo. •Avoid ASA, alcohol, steroids or other OTC medications w/o prescriber approval •Report use to ALL health care provider •Avoid during pregnancy

Nursing Considerations: Adm with food to decrease GI upset
Assess: •Pain: frequency, characteristics, intensity; relief before and 1-2hr after adm •Arthritis: ROM, pain, swelling before and 1-2hr after use •Fever: before, 1hr after adm •Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, H/H, LDH, blood glucose, WBC, platelets, CCr before Tx, periodically thereafter during long-term therapy •BBW: GI status: ulceration, bleeding, perforation; may be fatal; obtain stool guaiac •BBW: cardiac status: CV thrombotic events, MI, stroke; may be fatal; not to be used in CABG. Alert: aspirin hypersensitivity or nasal polyps, increased risk of hypersensitivity Evaluate: Therapeutic response: decreased pain, stiffness, swelling in joints; ability to move more easily Teach: •Use sunscreen, photosensitivity. •Report blurred vision, ringing or roaring in ears (may indicate toxicity) •Report Cx in urine pattern, weight increase, edema (face, lower extremities), increased joint pain, fever, blood in urine (indicates nephrotoxicity); black stools, flulike symptoms•Therapeutic effects may take up to 1 mo. •Avoid ASA, alcohol, steroids or other OTC medications w/o prescriber approval •Report use to ALL health care provider •Avoid during pregnancy

Generic Name: promethazineBrand Name(s): Phenergan| Pregnancy Category: C| Route of Administration: PO, IM, IV, Rectally| Drug Category: antihistamine| Indication: antiemetic, Tx hyperemesis gravidarum| Drug Category: antihistamineNormal Dosage:N&VAdult: 12.5-25mg q4-6hr prnChild: >2yr 0.25-0.5 mg/kg q4-6hr prnHyperemesis gravidarum12.5 – 25 mg q4h| Side Effects:BBW – IV use. neonates, infants & children – intraarterial/SUBCUT administration, extravasationDizziness, drowsiness, neuroleptic malignant syndrome, constipation, urinary retention, thrombocytopenia, agranulocytosis, hemolytic anemia, apnea in neonates, infants, young children|

Nursing Considerations/Teachings/Interventions:
Nursing Consideration: can cause false positive on pregnancy test

Assess- N & V before & after dose, I & O, CBC, LFT’s (long-term),
Resp status, Cardiac Status, NMS (fever, confusion, diaphoresis, muscle rigidity, elevated CPK, encephalopathy, discontinue product & notify prescriber check for extravasation (BBW): pain/swelling at IV site

Teach: can cause photosensitivity so avoid over-exposure to sunlight. Notify prescriber of confusion, sedation, hypotension, jaundice, fever, risk of heat stroke d/t decreased sweating, use candy/gum/water to decrease dry mouth

Nursing Considerations/Teachings/Interventions:
Nursing Consideration: can cause false positive on pregnancy test

Assess- N & V before & after dose, I & O, CBC, LFT’s (long-term), Resp status, Cardiac Status, NMS (fever, confusion, diaphoresis, muscle rigidity, elevated CPK, encephalopathy, discontinue product & notify prescriber check for extravasation (BBW): pain/swelling at IV site

Teach: can cause photosensitivity so avoid over-exposure to sunlight. Notify prescriber of confusion, sedation, hypotension, jaundice, fever, risk of heat stroke d/t decreased sweating, use candy/gum/water to decrease dry mouth

Generic Name: ketorolacBrand Name(s): Toradol| Pregnancy Category: C| Route of Administration: PO, IM, IV| Normal Dosage:Adult >17 and > 50kg: PO continuation from IM/IV only 20mg then 10mg q4-6hr prn, max 40 mg/dayAdult/adolescent >17 yr and <50 kg: IM (single dose) 30-60mg, IV 15-30 mg q6hr, max 60 mg/day x 5 days combined either PO/IM/IVAdminister: Not to exceed 5 days IM: inj deep in large muscle massIV: give undiluted over >15 sec| Drug Category: non-steroidal anti-inflammatory/ non-opioid analgesic| Indication: analgesic, anti-inflammatory| Side Effects:BBW – Breastfeeding, severe renal disease, L&D, epidural.intrathecal adm, GI bleeding/ hypovolemiaBBW – children, geriatric pts, bleeding, MI, strokeDrowsiness, seizures, CV thrombotic events, MI, stroke, GI bleeding, perforation, hepatitis, hepatic failure, nephrotoxicity: dysuria, hematuria, oliguria, azotemiaBlood dyscrasias, angioedema, Steven-Johnson Syndrome, toxic epidermal necrolysis|

Nursing Considerations/Teachings/Interventions:
Assess-
* Aspirin sensitivity, asthma: patients may be more likely to develop hypersensitivity to NSAIDs: monitor for hypersensitivity * Pain: type, location, intensity, ROM before and 1 hr after Tx * BBW – Renal, hepatic blood studies: BUN, creatinine, AST, ALT, Hgb before Tx and periodically thereafter. Check for Dehydration. * BBW – bleeding times, check for bruising, bleeding, occult blood in urine * ALERT…Hepatic dysfunction: jaundice, yellow sclera and skin, clay-colored stools * BBW – CV thombotic events: MI, stroke

* Audiometric, ophthalmic exam before, during and after Tx Evaluate: therapeutic response, decreased pain, stiffness, swelling in joints, ability to move more easily. Teach: •Report blurred vision, ringing/roaring in ears (may indicate toxicity) •Report Cx in urine, weight increase, edema, pain increases in joints, fever, blood in urine (indicates nephrotoxicity): bruising, black tarry stools (indicates bleeding) •Avoid acetaminophen and other NSAIDs. •Not to breastfeed!

Nursing Considerations/Teachings/Interventions:
Assess-
* Aspirin sensitivity, asthma: patients may be more likely to develop hypersensitivity to NSAIDs: monitor for hypersensitivity * Pain: type, location, intensity, ROM before and 1 hr after Tx * BBW – Renal, hepatic blood studies: BUN, creatinine, AST, ALT, Hgb before Tx and periodically thereafter. Check for Dehydration. * BBW – bleeding times, check for bruising, bleeding, occult blood in urine * ALERT…Hepatic dysfunction: jaundice, yellow sclera and skin, clay-colored stools * BBW – CV thombotic events: MI, stroke

* Audiometric, ophthalmic exam before, during and after Tx Evaluate: therapeutic response, decreased pain, stiffness, swelling in joints, ability to move more easily. Teach: •Report blurred vision, ringing/roaring in ears (may indicate toxicity) •Report Cx in urine, weight increase, edema, pain increases in joints, fever, blood in urine (indicates nephrotoxicity):
bruising, black tarry stools (indicates bleeding) •Avoid acetaminophen and other NSAIDs. •Not to breastfeed!

Generic Name: OxytocinBrand Name(s): Pitocin| Pregnancy Category: C| Route: IV/IM| Drug Category: Exogenous hormones| Indication: To induce/stimulate labor; manage postpartum hemorrhage| Normal Dosage:Induce: Mixed in standard conc—10 units in 1000 mL of fluidBegin at 1 milliunit/min. ↑ 1 to 2 milliunits/unit every 30-60 mins until labor is established then ↓PPH: 10-40units/L in standard conc at 125-200milliunits/min OR 10-20units IM| Nursing Considerations/Teachings/Interventions:PPH: Use if massage if fundus, expression of clots in the uterus and elimination of bladder distension doesn’t work continue monitoring vaginal bleeding and uterine toneTEACH- Reason; Effects to expect: contractions will come regular and more oftenASSESSMENT- •Fetal q15mins & with change in dose during 1st stage of labor & q5min during the 2nd stage of labor •q15min and with every change in dose during pushing phase of the second stage of labor monitor the contraction pattern and uterine resting tone • BP, P, R every change in dose •I&O- limit IV intake to 1000 mL in 8 hrs; urine output should be 120 mL or more q4h •Observe emotional response|

Side Effects:MATERNAL-↓BP, uterine tachysystole, lacental abruption, uterine rupture, unnecessary cesarean birth due to FHR and pattern, postpartum hemorrhage, infectionFETAL- hypoxemia and acidosis– resulting in abnormal FHR and patterns| Uterine Tachysystole with OxytocinSIGNSMore than 5 contractions in 10 mins OR A series of single contractions lasting ≥2 mins OR Contractions of normal duration occurring within 1 min of each otherINTERVENTIONS (with normal (reassuring) FHR)•Reposition or maintain woman in side-lying position •Adm IV bolus 500 mL LR •IF has not returned to normal after 10 mins, ↓ by ½ •IF has not returned to normal after another 10 mins, DC until < 5 contractions occurring in 10 minutesINTERVENTIONS (with abnormal (nonreassuring) FHR)•DC stat •Reposition woman in side-lying position •Adm IV bolus 500mL LR •IF not resolved FHR give oxygen at 10L/min •IF no response, give 0.25 mg terbutaline SQ according to unit protocol or standing orders •Notify primary health care provider of actions taken ad maternal and fetal responsesRESUMPTION OF OXYTOCIN AFTER RESOLUTION If DC less than 20-30 minutes, resume at nor more than half the rate that caused itIf DC for more than 30-40 minutes, resume the initial start dose|

Generic Name: DolasetronBrand Name(s): Anzemet| Drug Category:Antiemetic| Pregnancy Category: B| Route:IV, PO| Indication: Prevention of Postoperative Nausea & Vomiting| Normal Dosage over 16 yrs old: Before surgery: PO 100mg within 2 hr (max, 100 mg/dose)15 min before cessation of anesthesia: IV 12.5 mg (max, 12.5 mg/dose)| Ped’s Dosage Children 2 to 16 yrs old:IV 0.35 mg/kg (max, 12.5 mg/dose) as a single dose as soon as nausea and vomiting presents.| Common Side Effects•Mild Headache •tired feeling •mild dizziness •N&D •constipation •anorexia •chills/shivering •numbness or tingly feeling •fever •sweating •rash •joint or muscle pain.| Life Threatening Side Effects •Hypersensitivity •Feeling like you may pass out •bradycardia •weak• pulse •bradypnea •swelling in your hands or feet headache with chest pain and severe dizziness, fainting, fast or pounding heart beat •urinating less than usual or not at all.|

Nursing Considerations/Teachings/Interventions
Monitor •serum potassium and magnesium levels • correct hypokalemia and hypomagnesemia prior to administration and monitor during therapy as clinically indicated. •Use ECG monitoring in elderly patients and patients with CHF, bradycardia, and renal impairment. General Advice

* Dolasetron injection may be mixed with apple or apple-grape juice for oral administration in children. Use within 2 h of dilution. * Infuse IV as rapidly as 30 sec or diluted in a compatible IV solution to 50 mL and infused over a period of up to 15 min. * Injection solution may be administered undiluted or may be diluted in a compatible IV solution to 50 mL. * Compatible IV fluids include sodium chloride 0.9%, dextrose 5%, dextrose 5% and sodium chloride 0.45%, dextrose 5% and Ringer’s lactate injection, and Ringer’s lactate injection and mannitol 10% injection. * Do not mix dolasetron injection with other drugs.

* Flush infusion line before and after administration.
* Inspect injection solution for particulate matter or discoloration before use.

Nursing Considerations/Teachings/Interventions
Monitor •serum potassium and magnesium levels • correct hypokalemia and hypomagnesemia prior to administration and monitor during therapy as clinically indicated. •Use ECG monitoring in elderly patients and patients with CHF, bradycardia, and renal impairment. General Advice

* Dolasetron injection may be mixed with apple or apple-grape juice for oral administration in children. Use within 2 h of dilution. * Infuse IV as rapidly as 30 sec or diluted in a compatible IV solution to 50 mL and infused over a period of up to 15 min. * Injection solution may be administered undiluted or may be diluted in a compatible IV solution to 50 mL. * Compatible IV fluids include sodium chloride 0.9%, dextrose 5%, dextrose 5% and sodium chloride 0.45%, dextrose 5% and Ringer’s lactate injection, and Ringer’s lactate injection and mannitol 10% injection. * Do not mix dolasetron injection with other drugs.

* Flush infusion line before and after administration.
* Inspect injection solution for particulate matter or discoloration before use.

Generic Name: CarboprostBrand Name(s): Hemabate| Drug CategoryOxytocics| Route:IM| Pregnancy Category: C| Indication: •Postpartum Hemorrhage •abortion (by uterine contractions between the 13th and 20th weeks of pregnancy, but may be given at other times for medical reasons. •often used when another method of abortion has not completely emptied the uterus, or when a complication of pregnancy would cause the baby to be born too early to survive.| Usual Adult Dose for Postpartum Bleeding:•Initial dose: 250 mcg (1 mL) deep IM-Clinical trials have reported that 73% of cases responded to single injections. -In some selected cases, multiple dosing at intervals of 15 to 90 minutes was reported to have had a successful outcome. The total dose should not exceed 2 mg (8 doses or 8 mL).| Usual Adult Dose for Abortion:•Initial dose: 250 mcg (1 mL) IM with tuberculin syringe. – May be administered at 1.5 to 3.5 hour intervals depending on uterine response. -An optional test dose of 100 mcg (0.4 mL) may be administered initially. The dose may be increased to 500 mcg (2 mL) if uterine contractility is judged to be inadequate after several doses of 250 mcg (1 mL). The total dose should not exceed 12 mg and continuous administration of the drug for more than 2 days is not recommended.|

Common Side Effects•Mild fever that may come and go •chills •numbness or tingly feeling •mild nausea or diarrhea •cough •breast pain/tenderness •menstrual type pain •ringing in your ears.| Life Threatening Side Effects•Hypersensitivity •severe pelvic pain, cramping, or vaginal bleeding •high fever •feeling light-headed or SOB severe N,V,D, •increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure)| Nursing Considerations/Teachings/Interventions:•Doseage amt of intervals determined by physician •Abortion induced by carboprost may be expected to be incomplete in about 20% of cases (the same percentage as with spontaneous abortions).•Fetus could exhibit transient signs of life following carboprost-induced abortion •If the pregnancy no terminated, complete abortion using another method Assess: Risk of cervical trauma– examine each patient for cervical injuries after abortion is complete.Caution in patients with a compromised (scarred) uterus. Contraindications •Fetus at viable stage •hypersensitivity •Acute pelvic inflammatory disease •Active cardiac, pulmonary, renal, or hepatic disease.Warnings: Administer by qualified professional personnel in a hospital where intensive care and surgical facilities are immediately available.|

Generic Name: DexamethasoneBrand Name(s): Baycadron, Dexamthasone, DexPak, Maxidex, Zema-Pak, Dexasol, Ozurdex| Drug CategoryGlucocorticoid, Corticosteriod| Pregnancy Category C| Route:IM| Normal Dosage 6 mg IM q12h for 4 doses• A single course of corticosteroids is recommended for pregnant women between 24 weeks and 34 weeks of gestation who are at risk of preterm delivery•A single course of antenatal corticosteroids should be administered to women with PROM before 32 weeks of gestation to reduce the risks of respiratory distress syndrome, perinatal mortality, and other
morbidities| Indication •prenatal treatment for the symptoms of congenital adrenal hyperplasia (CAH) in female fetuses •women at risk of delivering prematurely to promote maturation of the fetus’ lungs. This has been associated with low birth weight, although not with increased rates of neonatal death.|

Common Side Effects•Fluid Retention •↑BP •Hyperglycemia •Hypernatremia •Hypokalemia •Hypocalcemia| Life Threatening Side Effects •Cardiac Arrest •thromboembolism •convulsions •hypersensitivity| Nursing Considerations/Teachings/Interventions:•The efficacy of corticosteroid use at 32–33 completed weeks of gestation for preterm PROM is unclear based on available evidence, but treatment may be beneficial, particularly if pulmonary immaturity is documented.Laboratory Test Interactions•↑ urine glucose and serum cholesterol •↓ serum levels of potassium, T 3 and T 4 •↓ uptake of thyroid 131-iodine •false-negative nitroblue-tetrazolium test •altered brain scan results; suppression of skin test reactions. •False-negative results for the dexamethasone suppression test may occur in patients receiving indomethacin. •Fluid and electrolyte balance•Dietary salt restriction and potassium supplementation may be needed.|

Generic Name: Eythromycin Opthamalic Ointment 5mg/gBrand Name(s): Erthromycin Ointment, Romycin| Drug CategoryMacrolide Antibiotic| Pregnancy CategoryB| Route:Ointment, PO | Indication •Treatment of superficial ocular infections caused by strains of susceptible organism; •prophylaxis of neonatal conjunctivitis.| Normal Dosage depending on severity of infection for adults and Children: 1 cm ribbon of ointment placed in eye up to 6 times daily| Conjunctivitis of the NewbornPO 50 mg/kg/day in 4 divided doses for at least 14 days.Prophylaxis of Neonatal Gonococcal or Chlamydia Conjunctivitis in Newborns Ophthalmic 1-cm ribbon of ointment placed in each conjunctival sac at time of delivery.| Common Side EffectsEye stinging/burning/redness or temporary blurred vision| Life Threatening Side Effects Hypersensitivity|

Nursing Considerations/Teachings/Interventions:
Ophthalmic ointment
* For topical instillation in the eye only. Not for use in the ear or on the skin. * Wash hands before and after instilling ointment. Have patient tilt head backward or lie down and gaze upward. Gently pull down lower lid to form a pouch. Place prescribed amount of ointment with a sweeping motion inside the lower eyelid. Have patient close eye(s) for 1 to 2 min and roll the eyeball in all directions. Remove excessive ointment from around eye with tissue. * If using more than 1 ophthalmic ointment, wait at least 10 min before instilling second drug. * Caution patient to avoid contaminating ointment by not touching the tip of tube to any surface and to replace cap after using. * Advise patient that ointment may cause temporary blurring of vision and to avoid activities requiring visual acuity until blurring clears.

Use of this medication for prolonged or repeated periods may result in other types of eye infections, including fungal infections. Stop using this medication and contact your doctor if you notice new or worsening eye symptoms (such as pain, swelling, thick discharge or pus).

Nursing Considerations/Teachings/Interventions:
Ophthalmic ointment
* For topical instillation in the eye only. Not for use in the ear or on the skin. * Wash hands before and after instilling ointment. Have patient tilt head backward or lie down and gaze upward. Gently pull down lower lid to form a pouch. Place prescribed amount of ointment with a sweeping motion inside the lower eyelid. Have patient close eye(s) for 1 to 2 min and roll the eyeball in all directions. Remove excessive ointment from around eye with tissue. * If using more than 1 ophthalmic ointment, wait at least 10 min before instilling second drug. * Caution patient to avoid contaminating ointment by not touching the tip of tube to any surface and to replace cap after using. * Advise patient that ointment may cause temporary blurring of vision and to avoid activities requiring visual acuity until blurring clears.

Use of this medication for prolonged or repeated periods may result in other types of eye infections, including fungal infections. Stop using this
medication and contact your doctor if you notice new or worsening eye symptoms (such as pain, swelling, thick discharge or pus).

Generic Name: SimethiconeBrand Name(s): Mylicon, Bicarsim, Gas –X, Flatulex, Genasyme, Maalox, Phazyme| Drug CategoryAntiflatulent| Route of Administration:PO| Normal DosageCapsules: PO 125 mg 4 times daily after meals and at bedtimeTablets: PO 40-125 mg 4 times daily and at bed timeDrops: 40-80 mg 4 times daily (up to 500 mg/day)| Ped’s Dosage •Children 2 – 12 yrs old: Drops PO 40 mg 4 times daily•Children younger than 2 yrs old: Drops 20 mg 4 times daily (up to 240 mg/day)| Indication-Relief of painful symptoms and pressure of excess gas in digestive tract; adjunct in treatment of many conditions in which gas retention may be problem, such as postoperative gaseous distention and pain, endoscopic examination, air swallowing, functional dyspepsia, peptic ulcer, spastic or irritable colon, diverticulosis.- Treatment of Infant colic|

Pregnancy CategoryNo formal assigned to a pregnancy category by the FDA. Briggs et. al states that simethicone is probably compatible with pregnancy. There are no controlled data in human pregnancy. Simethicone is only recommended for use during pregnancy when benefit outweighs risk.| Nursing Considerations/Teachings/InterventionsTeach patient about maximum dosage allowance per day.| Side EffectsNone Well Documented|

Generic Name: Oxycodone Hydrochloride & AsprinBrand Name(s): Percodan| Drug CategoryOpioid Analgesic Combination| Pregnancy CategoryD| Route of Administration:PO| IndicationFor the relief of moderate to moderately severe pain.| Common Side Effects•Euphoric •sleepiness •cold sweats •blurred or loss of vision •constricted, pinpoint, or small pupils •double vision •cool pale skin| Life Threatening Side Effects Overdose symptoms: •extreme drowsiness •pinpoint pupils •N,V,D •confusion •ringing in your ears •cold or clammy skin •muscle weakness •fainting •weak pulse •bradycardia •coma •blue lips •shallow/absent breathing•Severe stomach pain, constipation, vomiting •black, bloody or tarry stools •coughing up blood or vomit that looks like coffee grounds •weak or shallow breathing •fast or slow heartbeats •confusion, hallucinations, feeling like you might pass out
•easy bruising or bleeding •seizures •↓ hearing, ringing in your ears.|

Normal Dosage•1 tablet (aspirin 325 mg/oxycodone 4.5-0.38 mg or aspirin 325 mg/oxycodone 4.8355 mg) •1 to 2 tablets (aspirin 325 mg/oxycodone 2.25-0.198 mg) orally every 6 hours.| Ped’s Dosage •5 years or younger: Use is not indicated. •6 to 12 years: One-fourth of an aspirin-oxycodone 325 mg-2.25 mg-0.19 mg tablet every six hours. •12 years or older: One-half of an aspirin-oxycodone 325 mg-2.25 mg-0.19 mg tablet every six hours.| Nursing Considerations/Teachings/Interventions:Percodan may impair your thinking or reactions. Avoid driving or operating machinery until you know how Percodan will affect you.Avoid taking acetaminophen (Tylenol) or an NSAID while you are taking Percodan, unless your doctor tells you to. NSAIDs include ibuprofen (Advil, Motrin), ketorolac (Toradol), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others.Avoid drinking alcohol. It may increase your risk of stomach bleeding while taking aspirin.|

Generic Name: Ampicillin| Drug Category Bactericidal Penicillin| Pregnancy Category B| Route: IM; IV: PO| Indication: •Bacterial Infx •Community acquired pneumonia •Endocarditis prophylaxis •Typhoid fever.| Normal Dosage PO: 250-500 mg PO q6h for infx; IM/IV: 2g for edocarditis prophylaxis; 1-2 g IV q 3h for bacterial meningitis| Ped’s Dosage:(<7 days, < 2000g) 50-100 mg/kg/day/2x; (<7days, > 2000g) 75-150 mg/kg/day/3x; (>7 days, >2000g) 100-200 mg/kg/day/4x| Common Side Effects: •NVD •Urticaria •Rash •Eosinophilia •Glossities •Stomatitis •Black hairy tongue •Candidiasis| Life Threatening Side Effects: •Anaphylaxis •Hypersensitivity •Serum sickness like rxn •Stevens Johnsons syndrome •Seizures|

Nursing Considerations/Teachings/Interventions
Assess •for contraindications• baseline head to toe. •Examine skin and mucous membranes. •Perform C&S at the site of infx. •Note respiratory status. •Examine the abdomen to monitor for AEs. Evaluate •renal function tests including BUN and creatinine clearance to assess the need for dose
adjustment Nursing Considerations/Teachings/Interventions

Assess •for contraindications• baseline head to toe. •Examine skin and mucous membranes. •Perform C&S at the site of infx. •Note respiratory status. •Examine the abdomen to monitor for AEs. Evaluate •renal function tests including BUN and creatinine clearance to assess the need for dose adjustment

Generic Name: Cefazolin
Brand Name(s): Ancef Brand dc’d in US| Drug Category: 1st Gen. Cephalosporine| Pregnancy Category B| Route: IM, IV| Indication: •Bacterial infx, •prophylaxis dental endocarditis •Community acquired pneumonia| Normal Dosage: IM/IV: 250-500mg q4-q8h| Ped’s Dosage: IM/IV: 25-50mg/kg/day in 3 or 4 divided doses.| Common Side Effects: •NVD •Rash •abdominal pain •anorexia •elevated ALT or AST •urticaria •thrombophlebitis.| Life Threatening Side Effects: •Stevens Johnson Syndrome •Nephrotoxicity •Anaphylaxis|

Nursing Considerations/Teachings/Interventions:
Teach •Ensure pt takes full course. •Provide small frequent meals as tolerated. •Provide mouth care and ice chips • Drink plenty of fluids and maintain nutrition • Report difficulty breathing, severe diarrhea, dizziness or weakness. • Avoid consuming alcohol while receiving cephalosporins and for at least 72 hours after completing the drug course Safety precautions •changing positions slowly •avoid driving and hazardous tasks, if CNS effects occur Assess •Check culture and sensitivity reports. • renal function. • Injection sites. •Monitor for difficulty breathing, severe diarrhea, dizziness or weakness.. Nursing Considerations/Teachings/Interventions:

Teach •Ensure pt takes full course. •Provide small frequent meals as tolerated. •Provide mouth care and ice chips • Drink plenty of fluids and maintain nutrition • Report difficulty breathing, severe diarrhea, dizziness or weakness. • Avoid consuming alcohol while receiving cephalosporins and for at least 72 hours after completing the drug course Safety precautions
•changing positions slowly •avoid driving and hazardous tasks, if CNS effects occur Assess •Check culture and sensitivity reports. • renal function. • Injection sites. •Monitor for difficulty breathing, severe diarrhea, dizziness or weakness..

Generic Name: ClindamycinBrand Name(s): Cleocin| Drug Category: Lincosamide| Pregnancy Category B| Route: IM, IV| Indication: •Mild to severe bacterial infx, •acute otitis media, •acute bacterial sinusitis.| Normal Dosage: PO:150-300mg q6h or 600-2700mg qd in 2 or 4 equal doses| Ped’s Dosage: PO:8-25mg/kg/d IM/IV:15-40mg/kg/d in 3 to 4 divided doses| Common Side Effects: •NVD •abdominal pain •rash •pruritis •jaundice •urticaria •hypotension •thrombophlebitis| Life Threatening Side Effects: •Anaphylaxis •Stevens Johnson Syndrome •Esophagitis| Nursing Considerations/Teachings/InterventionsTeach • ensure pt receives full courseAssess •C&S •hepatic and renal function & labs •ALERT: take additional precautions that include careful monitoring of GI activity and fluid balance and stopping the drug at the first sign of severe or bloody diarrhea|

Generic Name: Gentamicin| Drug Category Aminoglycoside| Pregnancy Category D| Route: IM, IV| Indication: •Bacterial Infection. •Respiratory infx in cystic fibrosis pts| Normal Dosage: 1-1.7 mg/kg q8h| Ped’s Dosage: (<8days,<28wks gestation) 2.5 mg/kg q24h; (<8 days old, 28-29wk gestation) 2.5mg/kg q18h;| Common Side Effects: •Elevated BUN or Cr •Dizziness •Vertigo •Tinnitus •Hearing loss •Injection site rxn| Life Threatening Side Effects: •Nephrotoxicity •Stevens Johnson Syndrome| Nursing Considerations/Teachings/InterventionsTeach •Ensure pt receives full course •Change position slowly •avoid driving and hazardous tasks •drink plenty of fluids and maintain nutrition •avoid exposure to other infx •report immediately any difficulty breathing, severe headache, loss of hearing, ringing in ears, or changes in urine output.Assess •for contraindications. •Assess baseline before adm •Monitor pt throughout full course for signs of nephrotoxicty, neurotoxicity, and bone marrow suppression. •Ensure pt is hydrated at all times. |

Generic Name: Vitamin KBrand Name(s): Phytonadine| Drug Category Coagulation Factors| Pregnancy Category C| Route: SC; IM; IV| Indication: •Hyperprothrominemia, •Neonatal Hemorrhagic disease prophylaxis. •Antidote for Warfarin | Ped’s DosageNeonatal 0.5-1mg administer w/n one hour of birth may repeat in 6 – 8 hrs if necessary.| Common Side Effects •Taste changes •Flushing •Injection site hematoma •Injection site pain| Life Threatening Side Effects Black box warning Severe rxns with IV use including death has occurred. Reactions resemble hypersensitivity or anaphylaxis. Restrict IV route to cases where other routes are not feasible. •Anticoagulant resistance •Hypersensitivity •Anaphylaxis •Hyperbilirubinemia •Hemolytic anemia| Nursing Considerations/Teachings/Interventions •Educate patients to the fact that vitamin K is given as a prophylactic for neonatal hemorrhage desease.|

Generic Name: Morphine SulfateBrand Name(s): Astramorph PF, Avinza, Depo Dur, Infumorph PF, Kadian, MS Contin, Oramorph SR| Drug Category: Opioid analgesic| Pregnancy Category: C| Route: PO/SQ/IM/IV| Normal Dosage: SQ/IM: 5-10mg q4hr PO: 10-30mg q4hr IV: 2.5-15mg diluted in 4-5mL water| Ped’s Dosage:SQ/IV: 0.05-0.2 mg/kg, max 15 mg PO: 0.2-0.5 mg/kg q4-6hr| Indication: Moderate to severe pain|

Common Side Effects: •Drowsiness •dizziness •confusion •headache •sedation •palpitations •nausea •vomiting •anorexia •constipation •cramps •urinary retention | Life Threatening Side Effects: •Seizures •bradycardia •shock •cardiac arrest •tachycardia •thrombocytopenia •respiratory depression •respiratory arrest •apnea |

Nursing Considerations/Teachings/Interventions: Assess •bowel signs/constipation- to see if need for laxative• signs of respiratory depression Teach • Change position slowly: orthostatic
hypotension could occur Black box warning: Abrupt discontinuation: gradually taper to prevent withdrawal symptoms Black box warning: Accidental exposure: if duramorph or infumorph gets on skin, remove contaminated clothing, rinse affected area with water Treatment of overdose: Naloxone (Narcan): 0.2-0.8mg IV, O2, IV fluids, vasopressors Nursing Considerations/Teachings/Interventions: Assess •bowel signs/constipation- to see if need for laxative• signs of respiratory depression Teach • Change position slowly: orthostatic hypotension could occur Black box warning: Abrupt discontinuation: gradually taper to prevent withdrawal symptoms Black box warning: Accidental exposure: if duramorph or infumorph gets on skin, remove contaminated clothing, rinse affected area with water Treatment of overdose: Naloxone (Narcan): 0.2-0.8mg IV, O2, IV fluids, vasopressors

Generic Name: NalbuphineBrand Name(s): Nubain| Drug Category: Opioid analgesic| Pregnancy Category: C| Route: IM/IV| Normal Dosage: 5-10mg IV q3hrs prn 10-20mg IM q3-4hrs prn| Indication: Moderate to severe labor pain and postoperative pain after cesarean birth| Common Side Effects: •Confusion •sedation •hallucinations, “floating” feeling •headache •dizziness •nervousness •sweating •palpitations •tachycardia •bradycardia •transient nonpathologic sinusoidal-like FHR •N/V •Dysuria | Life Threatening Side Effects: •Cardiac arrest •respiratory depression | Nursing Considerations/Teachings/Interventions: Assess •VS, pain scale and uterine activity before and after administration • palpate for bladder distention •Observe for respiratory depression – notify provider is respiration are less than 12per/min • If birth occurs 1-4hrs after dose, observe newborn for
respiratory depression •Encourage voiding every 2 hrs, •Use side rails and assist with ambulation May precipitate withdrawal symptoms in opioid-dependent women and their newborns Avoid use with MAOIs – unpredictable reaction may occur |

Generic Name: NaloxoneBrand Name(s): Narcan| Drug Category: Opioid antagonist, antidote| Pregnancy Category: C| Route: IV/IM/SQ| Indication: •Reverses opioid-induced respiratory depression in woman or newborn; •may be used to reverse pruritus from epidural opioids| Normal Dosage: Opioid overdose: 0.4-2mg IV, may repeat IV at 2-3min intervals up to 10mg, can use IM if IV unavailable Postoperative opioid depression: Initial dose 0.1-0.2mg IV at 2-3min intervals up to 3 doses until desired degree of reversal obtained, may repeat in 1-2 hrs if needed| Ped’s Dosage IV/IM/SQ: Initial dose is 0.1mg/kg, may be repeated at 2-3min intervals up to 3 doses until desired degree of reversal obtained| Common Side Effects: •N/V •sweating •hypo/hypertension •drowsiness •hyperventilation| Life Threatening Side Effects: •Seizures •ventricular tachycardia •sinus tachycardia •fibrillation •cardiac arrest •hepatotoxicity •pulmonary edema |

Nursing Considerations/Teachings/Interventions: •Do no give to women or newborn if the woman is opioid dependent- may cause abrupt withdrawal in the woman and newborn •If given to a woman for reversal of respiratory depression caused by opioid analgesic, pain will return suddenly Teach •Women should delay breastfeeding until medication is out of her system If given to a women for reversal of respiratory depression caused by opioid analgesic, pain will return suddenly Nursing Considerations/Teachings/Interventions: •Do no
give to women or newborn if the woman is opioid dependent- may cause abrupt withdrawal in the woman and newborn •If given to a woman for reversal of respiratory depression caused by opioid analgesic, pain will return suddenly Teach •Women should delay breastfeeding until medication is out of her system If given to a women for reversal of respiratory depression caused by opioid analgesic, pain will return suddenly

Generic Name: SimethiconeBrand Name(s): Equaline Extra, Strength Gas Relief, Gas-Relief, Gas-X, Mylanta Gas, Mylicon, Phazyma| Drug Category: Antiflatulent| Pregnancy Category: C| Route: PO| Indication: Flatulence| Common Side Effects: •Belching •rectal flatus •diarrhea| Normal Dosage: PO: 40-125mg max 500 mg/day | Ped’s Dosage PO: under 2: 20mg qid prnPO: 2-12yrs: 40-50mg max 240 mg/day | Nursing Considerations/Teachings/Interventions: Teach • after meals and at bedtime prn • Tablets must be chewed and suspension must be shook before pouringAssess for decreased bowel sounds Evaluate therapeutic response: reduction of abdominal gas, discomfort |

Generic Name: Magnesium SulfateBrand Name(s): Epson salts | Drug Category: IV – high alert, electrolyte| Pregnancy Category: B| Route: IM/IV| Indication:• Pre-eclampsia/eclampisa •PPHN •premature labor •magnesium deficiency| Normal Dosage: pre-eclampsia/eclampisa: 4-5 g IV; with 5 g IM in each gluteus, then 5g q4hr or 4 g IV inf, then cont inf, max 40g/day Premature labor: IV 4- 6g in 30min then 2-4g/hr until contractions stop | Ped’s Dosage Persistant pulmonary hypertension of the newborn (PPHN) in mechanically ventilated neonates: 33wks to term: IV 20-150 mg/kg/hr to maintain blood magnesium levels| Common Side Effects: •N,V,D •anorexia •cramps •electrolyte imbalance •flushing •sweating •confusion •hypotension •hypothermia | Life Threatening Side Effects: •Flaccid paralysis •circulatory collapse | Nursing Considerations/Teachings/Interventions: Eclampsia: seizure precautions, BP, EKG Magnesium toxicity: thirst, confusion, decrease in reflexes, I&O ratio, check for decrease urinary output|

Generic Name: ScopolamineBrand Name(s): Maldemar, Scopace, Transderm| Drug Category: Cholinergic blocker, antiemetic| Pregnancy Category: C| Route of Administration: Patch: motion sicknessSQ: nausea and vomiting | Indication: N/V| Normal Dosage: One patch SQ: 0.6-1 mg | Ped’s Dosage SQ: 0.006mg/kg; max 0.3mg/dose| Common Side Effects: •Confusion •sedation •headache •fatigue •weakness •postural hypotension •dryness of mouth •constipation •suppression of breastfeeding | Life Threatening Side Effects: •Paralytic ileus | Nursing Considerations/Teachings/Interventions: •I&O ration: retention commonly causes decreased urinary output Teach •Constipation: increase fluids • Hard candy, frequent drinks, sugarless gum to relieve dry mouth •Do not stop abruptly •Avoid driving or other hazardous activities because drowsiness may occur • If blurred vision, severe dizziness, drowsiness occurs, discontinue use and use another type of antiemetic|

Generic Name: docusate sodiumBrand Name(s): Colace| Drug Category: surfactants| Pregnancy Category: C| Route of Administration:PO, PR| Indication: stool soften: constipation| Common Side Effects:Abdominal cramping| Normal Dosage:Ages 12 & up: 50-300mg PO daily; PR enema 1
bottle single dose.| Ped’s Dosage:Ages 2-12: 20-150 mg PO daily as single dose| Nursing Considerations/Teachings/Interventions•Risk for dependence on laxatives •for those who shouldn’t strainTeach- •nutrition •Increase fluid intake •exercise|

Generic Name: misoprostolBrand name: Cytotec| Drug Category: Prostaglandin E1 analogues| Pregnancy Category: X| Route of Administration:Intravaginally| Dosage:25 mcg q3-6h up to 6 in a 24 hr period or until ripened cervix| Indication: Ripens the cervix making it softer and causing it to begin to dialate and efface it: stimulation if uterine contractions| Side Effects:With higher doses (e.g. 50mcg q6h) are more likely to cause SE: •N,V,D •fever •uterine systole •fetal passage of meconium| Black Box Warning: Miscarriage-often life threatening bleeding Do not use while pregnant Do not breast feed while on medication***| Nursing Considerations/Teachings/InterventionsInterventions •Informed consent •Antidote 0.25 mg of SQ terbutaline if adverse reactions• Void prior to insertion • lay side-lying for 30-40min after insertion- remove excess medication with NS soaked gauze wrapped around finger •If ripening but not labor has occurred—prepare to adm oxytocin (no less then 4h after last dose)Assess before and after each dose- •VS •FHR & pattern •Bishop score •status of labor CAUTION: Hx of asthma, glaucoma, renal, hepatic, or CV disorders|

Generic Name: misoprostolBrand name: Cytotec| Drug Category: Prostaglandin E1 analogues| Pregnancy Category: X| Route of Administration:PR| Dosage:800-1000 mcg rectally once | Indication: Management of postpartum hemorrhage; contraction of the uterus decreases bleeding| Common Side Effects:•Headache •N,V,D| Black Box Warning: Miscarriage-often life threatening bleeding Do not use while pregnant Do not breast feed while on medication***| Nursing Considerations/Teachings/Interventions•Contradicted with patient with Hx of prostaglandins allergy•Continue to monitor vaginal bleeding and uterine tone|

Generic Name: Terbutaline Brand Name: Brethine| Drug Category: Tocolytic (Beta2 agonist)| Pregnancy Category: B| Route/DosageSQ-give in
deltoid0.25 mg q4h no longer than 24h dc if intolerable adverse reactions| Indication: Relaxes smooth muscles, inhibiting uterine activity and causing bronchodilation •to prevent preterm labor| Common Side Effects:MATERNAL: •tachycardia •chest discomfort •palpations •tremors •dizziness •headache •N/V •nasal congestion •hypokalemia •hyperglycemia •hypotension | Life Threatening Side Effects:MATERNAL: •HR>130bmp •BP<90/60 •chest pain •cardiac arrhythmias •MI •pulmonary edema FETAL: •HR>180bpm •hyperinsulinemia, •hyperglycemia | Nursing Considerations/Teachings/Interventions

•Only for use in Preterm labor >20wk and <35wks
Contradictions: •hx of (pre)gestational diabetes •gestational HTN • (pre)eclampsia •hyperthyroidism •migraine headaches •significant hemorrhage Assess: Before and after •BP, P, FHR. •maternal glucose & K+ levels Monitor for signs of pulmonary edema (dyspnea, crackles, ↓O2). Interventions: •Notify physical of glucose >180 and K+ <2.5 mEq/L and other life threatening reactions. •Antidote: Ensure propranolol (Inderal) is available for adverse cardiovascular reactions. Nursing Considerations/Teachings/Interventions

•Only for use in Preterm labor >20wk and <35wks
Contradictions: •hx of (pre)gestational diabetes •gestational HTN • (pre)eclampsia •hyperthyroidism •migraine headaches •significant hemorrhage Assess: Before and after •BP, P, FHR. •maternal glucose & K+ levels Monitor for signs of pulmonary edema (dyspnea, crackles, ↓O2). Interventions: •Notify physical of glucose >180 and K+ <2.5 mEq/L and other life threatening reactions. •Antidote: Ensure propranolol (Inderal) is available for adverse cardiovascular reactions.

Generic Name: Methylergonovine maleateBrand Name(s): Methergine| Drug Category: Ergot alkaloids| Pregnancy Category: C| Route:IM, IVTablet| Indication: To prevent/treat postpartum hemorrhage caused by uterine atony or subinvolution (shorting 3rd stage labor & ↓ blood loss).| Normal Dosage:0.2 mg IM q2-4h max of 5 doses; For excessive bleeding- 0.2 mg IV in 1 minute; after first IM/IV dose- 0.2mg PO q6-8h for 2-7 days (DC if severe
cramping occurs)| Common Side Effects: •Dizziness •headaches •HTN •dyspnea •N/V| Life Threatening Side Effects:•Seizures •stroke| Nursing Considerations/Teachings/Interventions•Given if no response to firm massage of fundus or oxytocin Contradiction: •HTN •cardiac disease• Do not give if BP>140/90Assess: •BP/P •uterine response (especially with IV route) •uterine tone, characteristics & amount of vaginal bleeding •contractions- may continue for 45mins with IV and for 3hrs with PO/IM|

Generic Name: medroxyPROGESTERoneBrand Name(s): Depo-Provera, Provera| Pregnancy Category X| Drug Category- Antineoplastic; hormone; contraceptive (Progesterone derivative)| Route of Administration: IM, SQ, PO- duration 24hrs; excreted in urine & feces| Normal Dosage: ●2° amenorrh.; ERT; uter. bleeding- PO 5-10 mg/day ●Endometrial/renal CA- IM 400mg – 1mg q1wk ●Contraceptive- IM 150mg q12wk; SQ-104mg q3mo | Indication- ●Abnormal uterine bleeding; ●2° amenorrhea; ●contraceptive; ●endometrial change assoc. w/ estrogen replacement therapy (ERT); ●metastatic endometrial/renal ca| Common Side Effects- ●Nausea ●Gynecomastia ●Testicular atrophy ●Impotence ●Hyperglycemia ●Dizziness ●HA| Life Threatening Side Effects •Hypersensitivity •angioedema •spontaneous abortion •stroke •PE •MI •thromboembolism •cholestatic jaundice Black Box Warnings Breast CA, MI, Stroke, Thromboembolic disease, Thrombophlebitis, Cardiac Disease, Dementia, & Osteoporosis|

Nursing Considerations/Teachings/Interventions- Assess: ●daily weight, notify PCP of weekly gain of >5 lbs; ●bone mineral density; ●BP at beginning of treatment and periodically; ●I&O ratio, watch for edema and ↓ urine output; ●mental status; ●liver studies and jaundice Administration: ●Rotate IM sites; ●Oil solution deep in large muscle mass; ●Give PO w/ food or milk to ↓ GI symptoms; ●Use lowest effective dose
Teaching: ●Teach pt to avoid sunlight d/t photosensitivity; ●To report suspected pregnancy; ●To report breast lumps, edema, jaundice, HA, dyspnea, chest pain, blurred vision, etc… Evaluate Therapeutic Response: ●↓ abnormal uterine bleeding, ●absence of amenorrhea Nursing Considerations/Teachings/Interventions- Assess: ●daily weight, notify PCP of weekly gain of >5 lbs; ●bone mineral density; ●BP at beginning of treatment and periodically; ●I&O ratio, watch for edema and ↓ urine output; ●mental status; ●liver studies and jaundice Administration: ●Rotate IM sites; ●Oil solution deep in large muscle mass; ●Give PO w/ food or milk to ↓ GI symptoms; ●Use lowest effective dose Teaching: ●Teach pt to avoid sunlight d/t photosensitivity; ●To report suspected pregnancy; ●To report breast lumps, edema, jaundice, HA, dyspnea, chest pain, blurred vision, etc… Evaluate Therapeutic Response: ●↓ abnormal uterine bleeding, ●absence of amenorrhea

Generic Name: Calcium Gluconate (ca salt) | Pregnancy Category C| Drug Category- Electrolyte replacement–calcium product (salt)| Route of Administration PO- onset, peak, duration unknown, absorption from GI tract IV- onset immediate, duration ½ -2hr| Normal Dosage PO – 0.5-2g bid-qid IV – 0.5-2g at 0.5mL/min (10% solution) Max dose 3g | Ped’s Dosage PO/IV- 500mg/kg/day in divided doses| Indication- Prevention/Tx of ●Hypocalcemia ●Lead colic ●Hypermagnesemia ●Hypoparathyroidism ●Neonatal tetany ●Cardiac toxicity from hyperkalemia ●Vit D deficiency ●Ca antagonist (channel blocker) toxicity ●Hyperphosphatemia ●Osteoporosis prophylaxis| Common Side Effects ●N/V ●HA ●Muscle weakness ●Polyuria ●Thirst ●Burning at IV site ●Extravasation ●Lethargy ●Hypotension ●Bradycardia ●Constipation ●Severe venous thrombosis | Life Threatening Side Effects ●Shortened QT ●Heart Block ●Dysrhythmias ●Cardiac arrest (IV) ●Coma| Nursing Considerations/Teachings/Interventions Assess: ●ECG for ↓ QT and T wave inversion ●Calcium levels during tx ●Cardiac status ●Hypocalcemia Provide: Seizure precautions Evaluate: Therapeutic response: ●↓twitching; paresthesias; muscle spasms ●absence of tremors, seizures, dyspnea, dysrhythmias, and laryngospasm ●negative Trousseau’s sign, ●negative Chvostek’s sign, Teach: ●Pt to add foods high in Vitamin. D

●Pt to add calcium-rich foods to diet (dairy, shellfish, dark green leafy veggies) ●Pt to ↓ oxalate- and zinc- rich foods from diet (nuts, legumes, chocolate, spinach, soy) ●Pt to prevent injuries; ●Pt to avoid immobilization Nursing Considerations/Teachings/Interventions Assess: ●ECG for ↓ QT and T wave inversion ●Calcium levels during tx ●Cardiac status ●Hypocalcemia Provide: Seizure precautions Evaluate: Therapeutic response: ●↓twitching; paresthesias; muscle spasms ●absence of tremors, seizures, dyspnea, dysrhythmias, and laryngospasm ●negative Trousseau’s sign, ●negative Chvostek’s sign, Teach: ●Pt to add foods high in Vitamin. D ●Pt to add calcium-rich foods to diet (dairy, shellfish, dark green leafy veggies) ●Pt to ↓ oxalate- and zinc- rich foods from diet (nuts, legumes, chocolate, spinach, soy) ●Pt to prevent injuries; ●Pt to avoid immobilization

Generic Name: hydrOXYzineBrand Name(s): ANX; Vistaril; Atarax| Pregnancy Category C (2nd/3rd trimester)| Drug Category Antianxiety/antihistamine/ sedative/hypnotic; antiemetic| Indications ●pre-op anxiety; ●post-op nausea; ●to potentiate opioid analgesics; ●vomiting; ●sedation; ●pruritus; ●ethanol withdrawal | Normal Dosage Alcohol w/drawal- IM 20-100mg q4-6hr Anxiety- PO 50-100 mg qid(max 600mg/day); IM 50-100mg q4-6hr Insomnia (unlabeled)-PO 50-100mg 30-60min before bedtime; IM 50mg 30-60min before bedtime Pre & Post-op N/V- IM 25-100mg q4-6hr Pruritus- PO 25mg
tid-qid, preferred route; IM 50-100mg then q4-6 hrs prn Renal dose- PO CCr< 50mL/min, give 50% of dose| Ped’s Dosage Anxiety <6 yrs- PO 50 mg/day in divided doses Anxiety >6 yrs- PO 50-100mg/day in divided doses Pre & Post-op N/V- IM 1.1mg/kg as a single dose Pruritus <6yrs- PO 50mg/day in divided doses Pruritus ≥6 yrs- PO 50-100mg/day in divided doses; IM 0.5-1mg/kg/dose q4-6hr prn – Use PO when possible |

Route of Administration: ●IM (z-track) ●PO- onset 15-60min; duration 4-6 hr; half-life 3 hr; metabolized by liver; excreted by kidneys | Common Side Effects ●Dizziness ●Drowsiness ●Hypotension ●Dry mouth ●↑ Appetite ●N & D ●Weight gain ●Confusion ●HA ●Fatigue ●Depression ●Tremors | Life Threatening Side Effects ●Seizures Tx of Overdose: Lavage if orally ingested; VS; supportive care; IV norepinephrine for hypotension | Nursing Considerations/Teachings/Interventions- Caution: closed-angle glaucoma, COPD, renal/hepatic disease, asthma Contradictions: Insomnia; allergic rhinitis; and generalized anxiety disorder (GAD) Assess: ●P/BP (lying, standing) if systolic BP drop 20mmHg, hold product, notify prescriber ●Mental status: mood, sensorium, affect, anxiety, behavior, increased sedation Provide/Perform: Assistance w/ ambulation during beginning therapy, drowsiness & dizziness may occur Evaluate: Therapeutic response: decreased anxiety Teach: ●Medication is not to be used for everyday stress or for >4 months; ●Avoid OTC meds (cold, cough, hay fever) unless approved by prescriber; ●Avoid driving; ●Avoid alcohol & psychotropic meds; ●Not to discontinue medication quickly after long-term use; ●To rise slowly b/c fainting may occur|

Generic Name: ButorphanolBrand Name(s): Stadol| Pregnancy Category: C | Drug Category: Opioid analgesic (Mixed opioid antagonist, partial agonist)|
Route of Administration: IV- Onset 1 min, Peak 4-5 min, Duration 2-4 hr; deeply in large muscle mass Intranasal- Onset w/in 15 min, Peak 1-2 hr, Duration 4-5 hr IM- Onset 5-15min, Peak 30-60 min, Duration 2-4 hr| Normal Dosage: Mod.-Severe Pain- IM 1-4mg q3hr; IV 0.5-2mg q3-4hr prn; Intranasal 1 spray in 1 nostril, may give another dose 1-1 ½ hr later repeat if needed 3-4hr after last dose Opioid–induced Pruritus (unlabeled)- Intranasal 1mg (1 spray) in each nostril q4-6hr Intractable pruritus w/ inflamm. skin or systemic disease (unlabeled)- Intranasal 1-4mg/day | Indication: Moderate to severe pain, general. anesthesia induction/maintenance, headache, migraine, pre-anesthesia contradictions, Pruritus | Common Side Effects: ●Drowsiness ●Dizziness ●Confusion ●HA ●Sedation ●Euphoria ●Weakness ●Hallucinations ●N/V ●Anorexia ●Constipation ●Cramps| Life Threatening Side Effects: ●Respiratory depression ●Severe, fatal rxn’s to MAOI’s Treatment for Overdose: ●Naloxone HCl (Narcan) 0.2-0.8mg IV ●O2 ●IV fluids ●Vasopressors|

Nursing Considerations/Teachings/Interventions- Assess- ●For ↓fluid output (may indicate urinary retention) ●For w/drawal s/sx in opioid-dependent pts ●PE, Vascular occlusion, abscesses, ulcerations ● CNS changes (ex. LOC, Pupil reaction, etc…) ●Allergic Rxn’s: rash, urticaria ●Resp. Dysfunction: resp. depression, character, rate, rhythm, if <10/min, notify doctor ●Need for pain medication, physical dependence Provide/Perform: Safety measures: ●nightlight, ●call-bell w/in easy reach, ●assistance w/ ambulation Evaluate: Therapeutic response- ↓ pain

Teach: ●To report any symptoms of CNS changes, allergic rxn’s; ●Physical dependency may result when used for extended periods; ●W/drawal symptoms may occur: N/V, cramps, fever, faintness, anorexia Nursing Considerations/Teachings/Interventions- Assess- ●For ↓fluid
output (may indicate urinary retention) ●For w/drawal s/sx in opioid-dependent pts ●PE, Vascular occlusion, abscesses, ulcerations ● CNS changes (ex. LOC, Pupil reaction, etc…) ●Allergic Rxn’s: rash, urticaria ●Resp. Dysfunction: resp. depression, character, rate, rhythm, if <10/min, notify doctor ●Need for pain medication, physical dependence Provide/Perform: Safety measures: ●nightlight, ●call-bell w/in easy reach, ●assistance w/ ambulation Evaluate: Therapeutic response- ↓ pain

Teach: ●To report any symptoms of CNS changes, allergic rxn’s; ●Physical dependency may result when used for extended periods; ●W/drawal symptoms may occur: N/V, cramps, fever, faintness, anorexia

Generic Name: CodeineBrand Name(s): Paveral| Pregnancy Category: C| Drug Category: Opiate analgesic, Antitussive| Indication: Moderate to severe pain|
RouteIM- Onset 10-30min PO- Onset 30-60min SQ- IV- Give slowly by direct inj.| Normal Dosage: Pain- PO/IM/SQ 15-60mg q4hr prn Cough- PO 10-20mg q4-6hr, max 120 mg/day Diarrhea (unlabeled)- PO 30mg; may repeat qid prn Pain (bone, back, dental), arthralgia, migraine, myalgia, HA- PO/IM/SQ 15-60mg q4-6hr| Ped’s Dosage: Pain 6-17yr: PO 3mg/kg/day in divided doses q4hr prn Pain (bone, back, dental),migraine, arthralgia, HA, myalgia- ≥3 yrs- IM/SQ 0.5-1 mg/kg or 15mg/m2 (max 60 mg/dose) q4-6hr| Common Side Effects: ●Drowsiness ●CNS Depression ●N/V ●Anorexia ●Constipation ●Flushing ●Dizziness ●Rash ●Pruritus ●Sedation| Life Threatening Side Effects: ●Seizures ●Circulatory Collapse ●Respiratory Depression ●Respiratory Paralysis ●Anaphylaxis ●Neuroleptic Malignant Syndrome BLACK BOX WARNING: ●Myocarditis ●Bone Marrow Depression ●Hypotension| Nursing Considerations/Teachings/Interventions:
Contradictions: D, HA, arthralgia, bone/dental pain, migraine, myalgia, nonproductive cough Assess: ●Myocarditis (most commonly occurs during 1st month of use), if suspected, D/C ●Seizures (usually occur w/ higher doses) ●I&O ratio (palpate bladder if low urinary output occurs) ●Bone Marrow Depression (bilirubin, CBC, LFTs monthly) ●Orthostatic Hypotension ●Dizziness, faintness, palpations, tachycardia on rising ●EPS (akasthisia, tardive dyskinesia, pseudoparkinsonism) ● NMS (tachycardia, seizures, fever, dyspnea, diaphoresis, increased/decreased BP, notify Prescriber immediately) ●I&O’s (constipation, urinary output- qd) ●If diabetic, check blood glucose levels. Perform/Provide: ●Supervised ambulation ‘til stabilized on med; ●Pt should not stand for long periods Evaluate: Therapeutic response: ↓ emotional excitement, hallucinations, delusions, paranoia, reorganization of patterns of thought, speech Teach: ●Sx of agranulocytosis and need for blood tests weekly for 6mon ●Orthostatic Hypotension (ex. Standing up suddenly, avoid hot showers) ●Avoid abrupt withdrawal from med ●Avoid OTC meds (cough, hay fever, cold) unless approved by provider●Compliance with med regime

●EPS and oral hygiene, (candidiasis may occur) ●Heat may occur in hot weather ●Avoid driving ●Notify prescriber if pregnant or intention of getting pregnant Nursing Considerations/Teachings/Interventions: Contradictions: D, HA, arthralgia, bone/dental pain, migraine, myalgia, nonproductive cough Assess: ●Myocarditis (most commonly occurs during 1st month of use), if suspected, D/C ●Seizures (usually occur w/ higher doses) ●I&O ratio (palpate bladder if low urinary output occurs) ●Bone Marrow Depression (bilirubin, CBC, LFTs monthly) ●Orthostatic Hypotension ●Dizziness, faintness, palpations, tachycardia on rising ●EPS (akasthisia, tardive dyskinesia, pseudoparkinsonism) ● NMS (tachycardia, seizures, fever, dyspnea, diaphoresis, increased/decreased BP, notify Prescriber immediately) ●I&O’s (constipation, urinary output- qd) ●If diabetic, check blood glucose levels. Perform/Provide: ●Supervised ambulation ‘til stabilized on med; ●Pt should not stand for long periods Evaluate: Therapeutic response: ↓ emotional excitement, hallucinations, delusions, paranoia, reorganization of patterns of thought, speech Teach: ●Sx of agranulocytosis and need for blood tests weekly for 6mon ●Orthostatic Hypotension (ex. Standing up suddenly, avoid hot showers) ●Avoid abrupt withdrawal from med ●Avoid OTC meds (cough, hay fever, cold) unless approved by provider●Compliance with med regime ●EPS and oral hygiene, (candidiasis may occur) ●Heat may occur in hot weather ●Avoid driving ●Notify prescriber if pregnant or intention of getting pregnant

Generic Name: oxyCODONE/acetaminophenBrand Name(s): Percocet, Tylox, Endocet, Magnacet, Primalev, Roxicet, Xolox | Pregnancy Category B| Drug Category: Opiate analgesic; semi-synthetic derivative| Route of Administration: PO: Onset 15-30min, Peak 1hr, Duration 3-4hr, metab. by liver, excreted in urine and breast milk, crosses placenta, half-life 3-5hr, protein binding 45%| Normal Dosage: PO 10-30mg q4hr (5mg q6hr for concentrated product) Cont Rel- 10mg q12hr for opiate-naïve pts Give w/ antiemetic if N/V occur| Indication: Moderate to severe pain| Tx of Overdose: Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors| Common Side Effects: ●Drowsiness ●Dizziness ●Confusion ●HA ●Sedation ●Euphoria ●N/V ●Anorexia ●Constipation ●Cramps ●Rash| Life Threatening Side Effects: Respiratory DepressionBLACK BOX WARNING: ●Respiratory Depression/Dysfunction ●Opioid-naïve pts, substance abuse ●Increase toxicity: cimetidine, MAOI’s |

Nursing Considerations/Teachings/Interventions: Contradictions: Post-herpetic neuralgic (cont release)
Assess: ● Pain- intensity, location, type, characteristics, need for pain meds by pain/sedation scoring, physical dependence ●I&O ratio- check for decreasing output, may indicate urinary retention ●CNS Changes- dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction ●Allergic Rxn’s- rash, urticarial ●Bowel Status: constipation, stimulant laxative may be needed w/ fluids, fiber Perform/Provide: Assistance w/
ambulation

Evaluate: Therapeutic response- decrease in pain w/out dependence Teach: ●Pt to report any Sx of CNS changes, Allergic rxn’s ●Physical dependency may result from extended use ●W/drawal Sx may occur after long-term use (N/V, cramps, fever, faintness, anorexia) ●Avoid CNS depressants, alcohol ●Avoid driving, operating machinery if drowsiness occurs Nursing Considerations/Teachings/Interventions: Contradictions: Post-herpetic neuralgic (cont release)

Assess: ● Pain- intensity, location, type, characteristics, need for pain meds by pain/sedation scoring, physical dependence ●I&O ratio- check for decreasing output, may indicate urinary retention ●CNS Changes- dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction ●Allergic Rxn’s- rash, urticarial ●Bowel Status: constipation, stimulant laxative may be needed w/ fluids, fiber Perform/Provide: Assistance w/ ambulation

Evaluate: Therapeutic response- decrease in pain w/out dependence Teach: ●Pt to report any Sx of CNS changes, Allergic rxn’s ●Physical dependency may result from extended use ●W/drawal Sx may occur after long-term use (N/V, cramps, fever, faintness, anorexia) ●Avoid CNS depressants, alcohol ●Avoid driving, operating machinery if drowsiness occurs

Generic Name: Rho (D) Immune GlobulinBrand Name(s): HyperRHO, MICRhoGAM, RhoGAM, Rhophylac, WinRho| Drug CategoryImmune globulin| Pregnancy Category C| Route:IM| Indication •Rh-negative women not previously sensitized to the Rh o (D) factor after delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby •prophylaxis at 26 to 28 weeks’ gestation, antepartum fetomaternal hemorrhage, amniocentesis, chorionic villus sampling (CVS), ectopic pregnancy, abdominal trauma, percutaneous umbilical sampling, other obstetrical manipulative procedure, or actual or threatened abortion •for prevention of Rh immunization in any Rh-negative person after incompatible transfusion of Rh-positive blood or blood products (eg, RBCs, platelet concentrates, granulocyte concentrates).| Normal Dosage – Adult Postpartum IM If the newborn is Rh-positive, administer 300 mcg within 72 h of delivery. Additional doses are indicated when the patient has been exposed to more than 15 mL of Rh-positive RBCs. This may be determined by use of qualitative or quantitative tests for fetal-maternal hemorrhage.|

Antepartum (prophylaxis at 26 to 28 weeks’ gestation) IM Administer 300 mcg within 72 h of suspected or proven exposure to Rh-positive RBCs resulting from amniocentesis, CVS, or percutaneous umbilical blood sampling, abdominal trauma or obstetrical manipulation, ectopic pregnancy, threatened pregnancy loss after 12 weeks’ gestation with continuation of pregnancy; pregnancy termination (spontaneous or induced) beyond 12 weeks’ gestation. If antepartum prophylaxis is indicated, it is essential that the mother receive a postpartum dose if the infant is Rh-positive. If RhoGAM is administered early in pregnancy (before 26 to 28 wk), there is an obligation to maintain a level of passively acquired anti-D by administration of RhoGAM at 12-wk intervals.| Common Side Effects•Headache •chills •fever •Locals side effects of slight swelling •induration •redness •mild pain & discomfort at injection site •dizziness •hyperkinesias •abd pain & diarrhea •hypotension •vasodilation & tachycardia •puritus •rash •sweating.| Life Threatening Side Effects Hemolysis is an expected event related to the destruction of Rho (D) positive blood cells. It is thought that the majority of red blood cells are destroyed in the spleen; however, signs and symptoms of intravascular hemolysis (IVH) have been reported within 4 hours following intravenous administration of Rho (D) IGIV.

Complications of IVH have included death, acute onset or exacerbation of anemia, and renal insufficiency. Acute renal insufficiency has been reported within 2 to 48 hours following the onset of IVH with an average increase in serum creatinine of 3.5 mg/dL reported between 2 to 9 days.| Nursing Considerations/Teachings/Interventions: Do not inject IV. For IM use only.  In the case of postpartum use, the products are intended for maternal administration only. Do not inject the newborn.Live virus vaccines (eg, measles, mumps, polio, rubella) Immunoglobulin administration may transiently impair the efficacy of live attenuated virus vaccines such as measles, mumps, rubella, polio, and varicella. Ensure the immunizing health care provider is informed of recent therapy with Rh o (D) immune globulin IV so that appropriate measures can be taken. Do not give immunization with live vaccines within 3 mo after WinRho SDF administration.Laboratory Test InteractionsWinRho SDF contains maltose, which may give falsely high blood glucose levels when certain types of blood glucose testing systems are used (eg, glucose-dye-oxidoreductase method).

Rh o (D) immune globulin may affect the results of blood typing, the antibody screening test, and the direct antiglobulin (Coombs) test. Antepartum administration of Rho(D) immune globulin to the mother can also affect these tests in the newborn. Rhophylac can contain antibodies to other Rh antigens (eg, anti-C antibodies), which might be detected by sensitive serological tests following administration. WinRho SDF contains trace amounts of anti-A, anti-B, anti-C, anti-E, and other blood group antibodies (eg, anti-Duffy, anti-Kidd antibodies) that may be detectable in direct and indirect antiglobulin (Coombs) tests obtained following RhIG administration. Interpretation of direct and indirect antiglobulin tests must be made in the context of the patient’s underlying clinical condition and supporting laboratory data.|

Generic Name: Hepatitis B VaccinationBrand Name(s): Engerix-B, Recombivax HB, Recombivax HB Dialysis Formulation | Route of Administration: IM| Pregnancy Category: C| Normal DosageAt 0, 1, and 6 monthsRecombivax HB 5mg/0.5mLEnergix-B 10mg/0.5mL| Drug Category: Vaccines| Indication: Immunization for Hep B virus| Common Side EffectsRash, fever, erythema, swelling, and pain at injection site| Nursing Considerations/Teachings/InterventionsParental consent; wear gloves- administer in vastus lateralis with 25-gauge (5/8) needle DO NOT FORGET TO ASPIRATE; massage with dry gauze to increase absorption |

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