Nursing action for L&D meds

  1. 0
    hi everyone. i am making drug cards for my clinicals this sem which happnes to be in l&d and pediatrics units.

    i couldn't find info on my drugbook and on the net about the nursing actions on the following meds. can someone please help?

    1. tucks/witch hazel pads -- i couldn't find info when i search for tucks pads but i would when i just typed in "tucks" which could be cream, lotion. honestly i am not familiar with this at all. web did not help much coz i could see the actual product. web just showed pictures of the box that it comes in.

    2. rhogam -- confused about this one. since basically we are worried about possible reactions d/t blood typing/cross-matching/incompatibilities, the nurse should still watch for signs of anaphylactic reactions after administration right? and if so then that would be one nursing action after drug administration. would there be others?

    3. prenatal vitamins --- i have the ff. for nursing actions. are these correct?
    nursing actions:

    before:
    1. double check if pt has just eaten a nutritional bar because this could result in an overdose on certain nutrients.
    2. check if pt is taking any other supplements to avoid overdose.
    3. do not crush, break or open tablet or capsule form. tell pt not to chew it.
    4. advise pt not to take with milk, other dairy products, calcium supplements or antacids that contain calcium.
    5. iron supplementation should not be used with hemochromatosis/hemosiderosis.
    6. use with caution on pt with severe hepatic impairment.
    7. use with caution in pt with kidney stones d/t calcium content.
    8. use with caution on pt with severe renal impairment.
    after:
    1. check for signs/symptoms of overdose such as stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.
    sorry for the long question. i already used several sources but still couldn't find what i'm looking for.
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  3. 16 Comments so far...

  4. 2
    over my head, i hated L&D. You sound like your WAY in depth. I really could care less if a mom ate a nutritional bar before taking vitamins. i mean alcohol can't be consumed during pregnancy, so if a pregnant woman wants a nutrition bar, i'd let her eat a nutrition bar.

    Sorry, i'm not much help
    xtxrn and NeoPediRN like this.
  5. 0
    Quote from Jenni811
    over my head, i hated L&D. You sound like your WAY in depth. I really could care less if a mom ate a nutritional bar before taking vitamins. i mean alcohol can't be consumed during pregnancy, so if a pregnant woman wants a nutrition bar, i'd let her eat a nutrition bar.

    Sorry, i'm not much help

    It's ok. It's something to think about. Thanks for replying.
  6. 1
    I wouldn't stress over the nutrition bar. Most vitamins are water soluable. If the patient takes in a large amount of a vitamin due to food intake plus supplement, the kidneys will excrete the excess. Your concern would be more for her overall use of vitamin supplements that may double or triple what is in her prenatal vitamins.

    Tucks contain witch hazel which is used for comfort and cleansing of hemorrhoids and/or perineal lacerations.

    You are correct that Rhogam is a blood product, so you're on the right track there. But not every mother gets Rhogam. Who should receive this med and why?
    xtxrn likes this.
  7. 0
    Quote from Jolie
    I wouldn't stress over the nutrition bar. Most vitamins are water soluable. If the patient takes in a large amount of a vitamin due to food intake plus supplement, the kidneys will excrete the excess. Your concern would be more for her overall use of vitamin supplements that may double or triple what is in her prenatal vitamins.

    Tucks contain witch hazel which is used for comfort and cleansing of hemorrhoids and/or perineal lacerations.

    You are correct that Rhogam is a blood product, so you're on the right track there. But not every mother gets Rhogam. Who should receive this med and why?
    So for Tucks, I should still look for signs&symptoms of allergic reaction right?
  8. 0
    You're getting hung up here. Of course you monitor for s/s of an allergic reaction with ANY med. That's a given, but it does not demonstrate that you have any knowledge of these specific meds.

    What are you assessing for in a patient who is using Tucks? Start there and figure out your nursing interventions.

    Why do you give Rhogam to some mothers, but not others? Answer that question, and you'll be able to figure out the important nursing considerations of that drug.
  9. 1
    i guess our witch hazel bush/tree, which is over 100 years old, doesn't know it shouldn't be growing and prospering this far north. i brewed the bark and strained it one summer but it was far too weak and besides that, it made the whole house smell awful! i tried it again outside and it stung it was so strong. it smelled horrorendous that time too! how to meet all the neighbors you haven't met yet!:d


    uses
    witch hazel is mainly used externally on sores, bruises, and swelling. the main constituents of the extract include tannin, gallic acid, catechins, proanthocyanins, flavonoids (kaempferol, quercetin), essential oil (carvacrol, eugenol, hexenol), choline, and saponins. distilled witch hazel sold in drug stores and pharmacies typically contains no tannin.[citation needed]
    witch hazel hydrosol is used in skin care. it is a strong anti-oxidant and astringent, which makes it very useful in fighting acne.[1] it is often used as a natural remedy for psoriasis, eczema, aftershave applications, ingrown nails, to prevent sweating of the face, cracked or blistered skin, for treating insect bites, poison ivy, and as a treatment for varicose veins and hemorrhoids.[4] it is found in numerous over-the-counter hemorrhoid preparations. it is frequently used by women to reduce swelling and soothe wounds resulting from childbirth.[5]
    witch hazel is also traditionally known as a good first reaction against shaving cuts and abrasions, and it is also recommended as effective for helping soothe sunburn.[citation needed]
    [edit] notes

    1. ^ a b steven foster group article
    2. ^ a b michael c. bingham, which witch is witch hazel (and which dickinson makes it)?, connecticut business journal, 20 october 1997.
    3. ^ about dickinson brands, dickinson brands website, accessed february 4, 2010.
    4. ^ webmd essay on medicinal uses of witch-hazel
    5. ^ http://www.mayoclinic.com/health/pos...m-care/pr00142
    xtxrn likes this.
  10. 0
    Tucks---- 'roid pads.... tell her not to suck on them Unless there's some allergy to witch hazel, there shouldn't be much to worry about. I'd recommend a clean tush, and to not glop on a bunch of other stuff that might limit its effectiveness. Repeat after any sitz baths (do they still do those?) Might get one of those snazzy donut cushions for her to sit on... And monitor for pain relief/effectiveness. No need to go scoping the exit valve, unless you have to do some ridiculous assessment (normally, nurses just ask if things feel better, and if the patient WANTS you to look at the back door- go for it...)

    Seriously, the nutrition bar (while probably correct for student purposes) IRL is not an issue- the toxic amount of fat soluble vitamins requires a LOT of nutrition bars over a fairly long period of time. BUT, with the prenatal vitamins, you might also check for vit K in them, and any warfarin she's taking- big issue w/the warfarin...not that she couldn't have the prenatals, but would need to be consistent with them and the warfarin to keep the INRs as steady as possible.
  11. 0
    Let me move this to the nursing student assistance forum.
  12. 0
    Hi- I am an L&D nurse and also a A- mother. Besides the above mentioned considerations. Rhogam is a blood product, but after delivery we draw maternal blood to look for any maternal-fetal blood mixing. Make sure you know what rhogam is for. The dose is titrated for the specific mom. Also the women is given a card to indicate she has received it. She needs to be made aware so if she needs blood products in the near future the blood bank is made aware to explain the antibodies.
    Also I tell my moms to put the Tucks in the fridge it really helps with post partum healing and itching. I know this one first hand. Hope that helps. Jen


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