Labor Cowboy - page 2

I was given this nick name the other night , I guess it is a compliment:). I was given that name because as the midwive put it , " I am willing to ride a lot of crap out and will do almost anything... Read More

  1. by   SmilingBluEyes
    Listed as a side-effect of TERBUTALINE: (among several) PULMONARY EDEMA.

    Found in the Family Notebook under OB drugs website (I have misplaced my drug handbook, sorry!).....anyhow...this is just me:

    ..I would think the danger of pulmonary edema in a gravid woman who likely has LOTS of PO or IV fluids on board already, (or likely WILL), may be even greater since her cardiac output increases so dramatically during pregnancy, esp. in the hours during and immediately following labor. Just my thoughts. I would be very cautious in using Trendenlburg positioning in anyone who is in labor w/lots of fluids on board, esp. in conjunction w/ using Terb.

    I have SEEN pulmonary edema a couple times, once in a preterm labor patient, another time, a lady recently delivered.... very humbling...and it happens FAST! Always plusses and minuses to all interventions we do.. as we know...we have to weigh them very carefully. I am not saying not to use this position when indicated; I am just supporting the pulmonary edema theory....:kiss
    Last edit by SmilingBluEyes on Sep 12, '02
  2. by   imenid37
    i think the terb causes pulm. edema because of the inc. hr it causes and subsequent inefficiency in pumping blood and the tendency for it to "back up" into the lungs. in an older gravida, i have actually seen some literature which suggests an ecg before therapy w/ terb. this is also why only a 500cc bolus should be given to try to suppress ptl if your next step is terb. i have seen pulm. edema in 2 terb. pts. over the years. one had an undiagnosed heart valve stenosis (i don't remember exactly-mitral stenosis maybe) and the other had also recieved mega-doses of mag sulfate. the lady w/ the valve problem had to have a swan-ganz at delivery and open heart surgery when her child was several months old.
  3. by   bagladyrn
    Terbutaline used in conjunction with or closely followed by Mag. Sulfate greatly increases the risk of pulmonary edema.
  4. by   mother/babyRN
    I have had patients on Mag go into pulmonary edema, and as a former cardiac nurse, definitely recognized the signs...Do you find some people don't routinely do breath sounds? I recall fighting with some docs who just didn't believe it was happening. Well, all your explanations make great sense.....Thanks a bunch!
  5. by   SmilingBluEyes
    Yep mother/baby RN, you are right, Breath sounds are routinely neglected in OB......and we need to be paying attention more. You bring up a VERY valid point!
  6. by   labornurse
    We have a great ob where I work. He insists that we report breath sounds and well as other pertinent data when we up date him on a labor pt. I was trained that way. I have never tried trendelenberg position in conjunction with terb. I have learned a lot today though and if I do, I will definately use with caution. Thanks for the info.
  7. by   mother/babyRN
    I have learned a bunch too..Again, thanks to all.....What do we tell the patients? No question is dumb unless you don't ask it. Might as well live by our own rules...
  8. by   mark_LD_RN
    imenid37- you are correct about the increased hrt rate decreasing pumping efficiency of hrt, thus increasing risk of pulmonary edema.

    on the subject of breath sounds i always assess breath sounds on labor patients once when i get on shift and at least everry 2 hours if on pit or mag.

    the trndelenburg was used to relieve cord compression,terbutiline was to stop ctx,hopefully relax uterus some and give baby a rest. pt was in trendy only cpl minutes till everything straightened out. in the mean time i had a maternal ekg leads on her and frequently monitored her breath sounds.

    Oh, they also tease me because i just bought a new 2oo dollar phillips electronic stephascope to replace my littman i love this one. i can hear everything with it.
  9. by   obtnt
    Here again is the RESPONSIBLE USE of IV fluids in the laboring pt! In the old days we did stat EKG and blood sugar on any pt BEFORE she recv'd terb. Then, when we started using brethine sq the docs had to give it!! As for the trendelenberg, it was a spontainious decision based on the moment, I bet. No one would routinely leave a pt with terb in trend. It was a success and one of those professional decisions!! Excellent outcome--right choice!! I think maybe some of us are not aggressive enough to prevent the many c-sections due to complaicency (sp?)! BUT we also need to be diligent with our use of IVF's because it is my opinion many haven't seen the serious consequences of pulmonary edema.