Nursing action for L&D meds

[nursingstudent_2012]

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.

[JenG2011]

In response there is a difference between Ante-partum and post-partum rhogam. The shot helps protect the baby during the pregnancy from being "attacked by the mother" if they are incompatable and the mother is already sensitized. If it is her first pregnancy rhogam will protect the mother from creating the antibodies in the first place. Read about rhogam and it's history. Without it many mothers would only be able to have one child or some none. Post partum it is given to protect the mother again from the antibodies she might create from getting fetal blood into her system during delivery. Rhogam also used during any potential exchange like during an amnio. Jen

[Jenni811, RN]

So for Tucks, I should still look for signs&symptoms of allergic reaction right?

Look for allergic reaction with everything, even tucks.

never seen anyone allergic to Tucks. but just the other day i saw a tv show where a girl was allergic to water, so anything is possible.

[nursingstudent_2012]

Based upon this statement, I don't think you understand what Rhogam is and what it does. Giving an injection to the mother post-delivery does not protect her newborn from anything. Please read up on this med so that you understand its function.

What nursing considerations do you have for Rhogam?

I was refering to the postpartum stage.

Here are the nursing considerations that I have so far:

Before:

1. Pt with immunoglobulin A deficiency may develop immunoglobulin A antibodies and have anaphylactic reaction; must weigh benefits of treatment against risk of hypersensitivity reactions before giving.

2. Obtain and review hx of allergies and reactions to immunizations. Keep epinephrine 1:1,000 ready to treat anaphylaxis.

3. Immediately after delivery, send a sample of neonate's cord blood to laboratory for typing and cross-matching. Confirm if mother is Rho (D)-negative and Du -negative. Give drug to mother ONLY IF infant is Rho (D)- OR Du -positive. Administration must occur w/in 72 hours of delivery.

4. Use with caution in pt with thrombocytopenia or coagulation disorders; hemorrhage/hematoma may occur from IM administration.

After:

1. Monitor for s/s of intravascular hemolysis (IVH), anemia, renal insufficiency, back pain, shaking, chills, discolored urine, or hematuria for 8 hours after administration.

2. Assess pt for difficulty breathing, tachycardia, back rash, pain, redness, swelling or pain at injection site, decreased urine output, peripheral edema.

[Jolie, BSN]

I was refering to the postpartum stage.

I thought so, which is why I reiterate my statement that I don't think you understand the mechanism of action of this drug. Giving Rhogam to a mother post-delivery does not protect her newborn from anything.

You also mention "poisoning" in a previous post, which further leads me to believe that you don't understand the pathophysiology of Rh incompatibility or its prevention.

Good luck on your assignment.

[JenG2011]

correction to my statment above. I was reading what I wrote and I made a typo. I meant to say Rhogam only works if the mother "is not already" sensitized. Once the antiboidies are created they cannot be removed. Rhogam will hopefully prevent that. You are working hard hope you do well!! Jen