Western Mindanao State University College of Nursing Zamboanga City

REQUIREMENTS IN ROTATION 10

SUBMITTED BY:

Antoniette C. Dumdumaya BSN 4-K

SUBMITTED TO:

Mrs. Deanna Sanchez RN MAN Clinical Instructor

November 5, 2013

STAGES OF LABOR
FIRST STAGE The first stage consists three phases: latent active and transition. this stage begins with the first true contraction and ends with complete effacement and dilation to 10 cm. Latent Phase (Early Labor) Duration: 10 to 12 hours for a woman who has had children. For first pregnancies, it may last closer to 20 hours Cervical dilation is 1 to 4 cm Uterine contraction occur every 15-30 minutes and are 15-30 seconds in duration and mild intensity Mother is talk active Encourage mother and partner to participate in care Change position and ambulation to comfort mother Offer fluids an ice chips Inform the progress to mother and partner Encourage voiding every 1-2 hours

Active Phase Duration 2-4 hrs in primipara and 2-4 in multipara Cervical dilation is 4-7 cm Uterine contraction occur every 3-5 minutes and are 30-60 seconds in duration and of moderate intensity Mother becomes restless and anxious as contraction become stronger Mother may experience feeling of helplessness Encourage mother in maintenance of effective breathing Provider a quiet environment Inform the progress to mother and partner Backrubs, sacral pressure, pillow support and position changes to promote comfort Offer fluids and ice chips instruct partner in effleurage Encourage voiding every 1-2hours

Transitional Phase Duration: 2-4 hrs in primipara and 1-2 in multipara Cervical dilation is 8-10cm Uterine contraction occur every 2-3 minutes and are 45-90 seconds in duration and strong intensity Mother may becomes tired, restless, irritable and feels out of control Encourage rest between contraction Inform the progress to mother and partner Provide privacy Offer fluids and ice chips Encourage voiding every 1-2 hrs

Nursing intervention Monitor vital signs Monitor fetal heart rate via ultrasounds Doppler, fetoscope or electronic fetal monitor Assess fetal heart rate before during and after a contraction Monitor uterine contraction by palpating determining frequency, duration and intensity of contraction Assess fetal station presention and position by Leopolds maneuver Assess the color of the amniotic fluid if the membranes have ruptured because meconiumstained fluid can iridicate fetal distress

SECOND STAGE Second stage of labor begins with complete dilation and ends with delivery of infant Duratin; 30-90 minutes in primipara and 15-20 minutes in multipara Cervical dilation complete Uterine contraction occur every 2-3 minutes, lasting 60-75 seconds and the intensity is strong Increase in bloody show Mother feels urge to bear down

Nursing intervention Assess fetal well being continuously Monitor maternal vital signs Encourage pushing Encourage deep-full breath(not to hld breath linger than 5 seconds when pushing) Commend mothers effort

THIRD STAGE Third stage of labor with delivery of infant and ends with delivery of placenta Duration: up to 20 minutes( primipara or multipara) Contraction occur until the placenta is born Placenta separation and expulsion occur Birth of placenta occurs 5-30 minutes after birth the baby

Nursing intervention Assess maternal signs and uterine status Observe for placenta separation Observed mother for signs altered LOC or altered respiration( indicate aneurysm or emboli) allow maternal-infant interaction as soon as possible LAST STAGE Last stage of labor begins with delivery of placenta and ends with postpartum stabilization Duration: usually 1-2 hrs after delivery( primipara and multipara) Blood pressure returns to thepre-labor level Pulse is slightly lower than during labor Fundus remans contracted, in the midline 1-2 fingerbeadths below the umbilicus

Nursing intervention Maternal assessment every 15 minutes for 1 hrs every 30 minutes for 1 hrs and hourly for 2 hours Administer oxytocin product if ordered Assess fundus every 15 minutes if soft, massage with side of hand Assess lochia, checking peripad and under lower back Assess bladder for distention because full bladder will prevevnt contraction and increase bleeding Assess episiotomy for intactness and possible bleeding

ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC) EVIDENCE-BASED STANDARD PRACTICES

The EINC practices are evidenced-based standards for safe and quality care of birthing mothers and their newborns, within the 48 hours of Intrapartum period (labor and delivery) and a week of life for the newborn. Developed and field tested by international and local experts, EINC practices reflect current knowledge. EINC distinguishes the necessary practices in the delivery and care for the newborn and the mother, from the unnecessary. In December 2009, the Secretary of the Department of Health Francisco Duque signed Administrative Order 2009-0025, which mandates implementation of the

EINC Protocol in both public and private hospitals. Likewise, the Unang Yakap campaign was launched. The EINC practices during Intrapartum period
1. 2. 3. 4. 5. 6. 7. 8.

Continuous maternal support, by a companion of her choice, during labor and delivery Mobility during labor the mother is still mobile, within reason, during this stage Position of choice during labor and delivery Non-drug pain relief, before offering labor anesthesia Spontaneous pushing in a semi-upright position Episiotomy will not be done, unless necessary Active management of third stage of labor (AMTSL) Monitoring the progress of labor with the use of pantograph

Recommended EINC practices for newborn care are time-bound interventions at the time of birth
1. 2. 3. 4.

Immediate and thorough drying of the newborn Early skin-to-skin contact between mother and the newborn Properly-timed cord clamping and cutting Unang Yakap (First Embrace) of the mother and her newborn for early breastfeeding initiation

1. IMMEDIATE AND THOROUGH DRYING A. Ensure quality provision of time bound interventions. B. Within the first 30 seconds dry and provide warmth the newborn to prevent hypothermia 1. Put on gloves (double gloves) 2. Use clean and dry cloth to thoroughly dry newborn by wiping the eyes, face, head, front, back, arms and legs 3. Remove wet cloth cover baby with another clean and dry warm cloth 4. Do not wipe off vernix caseosa if present. The vernix is a protective barrier to bacteria such as E. Coli and Group B Strep. 5. Do a quick check of the newborns breathing 6. Do not separate baby from the mother if newborn must be separated from the mother put baby on a warm surface in a safe close to the mother 7. Do not put newborn on a cold or wet surface 8. Use radiant warmer or heat source if resuscitation is required 9. Do not bathe the newborn earlier than 6 hours of life. Washing expose the baby to hypothermia. Washing also removes the crawling reflex. Partial and incomplete drying gives risks to hypothermia which can lead to Infection Coagulation defects Acidosis Delayed fetal to newborn circulatory adjustment Hyaline membrane disease Brain hemorrhage 2. EARLY SKIN TO SKIN CONTACT A. B. C. D. Place the newborn on prone position unto the mothers abdomen or chest, skin to skin Cover the newborns back with a blanket and head with bonnet Place the identification band on the ankle Do not separate the newborn from the mother as long as the newborn does not exhibit severe chest in drawing, gasping or apnea and the mother does not need urgent stabilization.

Skin to skin contact is generally perceived to be an intervention for the provision of warmth and bonding. Appreciated contributions are to the following: Immuno-protection of the newborn

Colonization with maternal skin flora Stimulation of the mucosa- associated with the lymphoid tissue system Ingestion of colostrum Overall success of breastfeeding Studies show that delayed breastfeeding has a greater risk of death due to infection. Protection from hypoglycemia 90 minutes after birth, blood glucose levels are significantly higher

3. PROPERLY TIMED CORD CLAMPING 1. Remove first set of gloves prior to cord clamping 2. Clamp the cord aseptically and cut the cord after the pulsations have stopped between 1 to 3 minutes after birth to allow for transfusion of blood from the placenta to the newborn. 3. Do not milk the cord towards the newborn. a. Put the clamp tightly around the cord 2cm and 5cm from the abdomen of newborn b. Cut between the clamp with sterile instrument c. Observe for oozing of blood d. After clamping, give oxytocin to the mother. Note: Clamp and cut the cord immediately only if the baby requires help with breathing. Delayed Cord Clamping is found to: a. Increase the newborns iron reserves b. Reduces the incidence of Iron Deficiency Anemia (IDA) in infancy 4. NON SEPARATION OF NEWBORN AND MOTHER FOR EARLY BREASTFEEDING 1. 2. 3. 4. 5. 6. Within 90 minutes of age, facilitate the newborns early initiation to breastfeeding and transfer of colostrum. Leave the newborn on the mothers chest in skin-to-skin contact. Health workers should not touch the newborn unless there is medical indication. Counsel mother on positioning infant and attachment to breast. If attachment is not good, reassess. Suggest mother to assist baby towards the breast. Advice mother not to throw away colostrum. Advice mother to start feeding once the newborn shows feeding cues like opening the mouth, licking and rooting. Encourage the Kangaroo Mother Care. Kangaroo mother care provides the newborn with low birth weight or preterm babies with benefits of incubator care. Once baby is stable, kangaroo mother care can begin.

Unnecessary interventions eliminated The unnecessary interventions during labor and delivery, which do not improve the health of mother and child, are eliminated. These are enemas and shavings, fluid and food intake restriction, and routine insertion of intravenous fluids. Fundal pressure to facilitate second stage of labor is no longer practiced, because it resulted to maternal and newborn injuries and death. Likewise, the unnecessary interventions in newborn care which include routine suctioning, early bathing, routine separation from the mother, foot printing, application of various substances to the cord, and giving pre-lacteals or artificial infant milk formula or other breast-milk substitutes. Government and international Support Since 2010, WHO supports the DOH in changing practices for safe and quality care of mothers and newborns for all practitioners and health facilities. It was initially implemented in 11 selected government hospitals collectively representing about 70,000 annual live births (around 3% of all national live births). AusAID also provided support through the Joint Programme on Maternal and Neonatal Health (JPMNH).

The eight steps of essential newborn care Before you look at the eight steps of essential newborn care (ENC) you need to remember the importance of the three cleans that you learned in Study Session 3 of the Labour and Delivery Care Module. These are clean hands, clean surface and clean equipment. Your equipment should include two clean dry towels, cord clamps, razor blade, cord tie, functional resuscitation equipment, vitamin K, syringe and needles, and tetracycline eye ointment.

Figure 2.1 Drying and wrapping the newborn baby. Step 1 Deliver the baby onto the mothers abdomen or a dry warm surface close to the mother. Continue to support and reassure the mother. Tell her the sex of the baby and congratulate her. Step 2 Dry the babys body with a dry warm towel as you try to stimulate breathing. Wrap the baby with another dry warm cloth and cover the head (Figure 2.1). Dry the baby well, including the head, immediately and then discard the wet cloth. Wipe the babys eyes. Rub up and down the babys back, using a clean, warm cloth. Drying often provides sufficient stimulation for breathing to start in mildly depressed newborn babies. Do your best not to remove the vernix (the creamy, white substance which may be on the skin) as it protects the skin and may help prevent infection. Then wrap the baby with another dry cloth and cover the head. Step 3 Assess breathing and colour; if not breathing, gasping or there are less than 30 breaths per minute, then resuscitate. You will remember that you learned how to manage a newborn baby with birth asphyxia in Study Session 7 of the Labour and Delivery Care Module. As you dry the baby, assess its breathing. If a baby is breathing normally, both sides of the chest will rise and fall equally at around 3060 times per minute. Thus, check if the baby is:

Breathing normally Having trouble breathing Breathing less than 30 breaths per minute, or Not breathing at all. Resuscitation of a baby who is not breathing must start within one minute of birth. If the baby needs resuscitation, quickly clamp or tie and cut the cord, leaving a stump at least 10 cm long for now and then start resuscitation immediately. Functional resuscitation equipment should always be ready and close to the delivery area since you must start resuscitation within one minute of birth. It may sound as if you have a lot to do in one minute, but the steps described here are ones that you can take simultaneously. That is, while you are delivering the baby onto the mothers abdomen and drying the baby, you can assess breathing and color and take urgent action if necessary. Figure 2.2 Tying and cutting the cord. Step 4 Tie the cord two fingers length from the babys abdomen and make another tie two fingers from the first one (Figure 2.2). Cut the cord between the first and second tie. If the baby needs resuscitation, cut the cord immediately. If not, wait for 73 minutes before cutting the cord. 1. Tie the cord securely in two places:

Tie the first one two fingers away from the babys

abdomen. Tie the second one four fingers away from the babys abdomen. Make sure that tie is well secured; the thread you use to tie the cord must be clean. Use a new razor blade, or a boiled one if it has been used before, or sterile scissors. Use a small piece of cloth or gauze to cover the part of the cord you are cutting so no blood splashes on you or on others. Be careful not to cut or injure the baby. Either cut away from the baby or place your hand between the cutting instrument and the baby.

2. Cut the cord between the ties:

3. Do not put anything on the cord stump. Step 5 Place the baby in skin-to-skin contact with the mother, cover with a warm cloth and initiate breastfeeding. The newborn loses heat in four ways (see Figure 2.3 below):

Evaporation: when amniotic fluid evaporates from the skin. Conduction: when the baby is placed naked on a cooler surface, such as the floor, table, weighing scales, cold bed. Convection: when the baby is exposed to cool surrounding air or to a draught from open doors and windows or a fan. Radiation: when the baby is near cool objects, walls, tables, cabinets, without actually being in contact with them. Figure 2.3 The newborn can lose heat in four ways. (Source: WHO, 1997, Safe Motherhood: Thermal Protection of the Newborn, a Practical Guide, accessed

fromhttp://whqlibdoc.who.int/ hq/ 1997/ WHO_RHT_MSM_97.2.pdf[Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]) The warmth of the mother passes easily to the baby and helps stabilise the babys temperature. 1. Put the baby on the mothers chest, between the breasts, for skin-to-skin warmth. 2. Cover both mother and baby together with a warm cloth or blanket. 3. Cover the babys head. The first skin-to-skin contact should last uninterrupted for at least one hour after birth or until after the first breastfeed. The baby should not be bathed at birth because a bath can cool the baby dangerously. After 24 hours, the baby can have the first sponge bath, if the temperature is stabilized.

Figure 2.4 Initiating immediate breastfeeding. If everything is normal, the mother should immediately start breastfeeding. For optimal breastfeeding you should do the following: 1. Help the mother begin breastfeeding within the first hour of birth (Figure 2.4). 2. Help the mother at the first feed. Make sure the baby has a good position, attachment, and is sucking well. Do not limit the length of time the baby feeds; early and unlimited breastfeeding gives the newborn energy to stay warm, nutrition to grow, and antibodies to fight infection.

The steps to keep the newborn warm are called the warm chain. 1. 2. 3. 4. 5. 6. 7. 8. Warm the delivery room. Immediate drying. Skin-to-skin contact at birth. Breastfeeding. Bathing and weighing postponed. Appropriate clothing/bedding. Mother and baby together. Warm transportation for a baby that needs referral.

Step 6 Give eye care (while the baby is held by its mother). Figure 2.5 Putting tetracycline eye ointment into the eyes of the newborn baby. Shortly after breastfeeding and within one hour of being born, give the newborn eye care with an antimicrobial medication. Eye care protects the baby from serious eye infection which can result in blindness or even death.

The steps for giving the baby eye care are these: First, wash your hands, and then using tetracycline 1% eye ointment: 1. Hold one eye open and apply a rice grain size of ointment along the inside of the lower eyelid. Make sure not to let the medicine dropper or tube touch the babys eye or anything else (see Figure 2.5). 2. Repeat this step to put medication into the other eye. 3. Do not rinse out the eye medication. 4. Wash your hands again. Step 7 Give the baby vitamin K, 1 mg by intramuscular injection (IM) on the outside of the upper thigh (while the baby is held by its mother). After following correct infection prevention steps, with the other hand stretch the skin on either side of the injection site and place the needle straight into the outside of the babys upper thigh (perpendicular to the skin). Then press the plunger to inject the medicine. You will be learning more about safe injection techniques in your practical skills training sessions. There is also a study session on routes of injection in the Immunization Module. Step 8 Weigh the baby. Weigh the baby an hour after birth or after the first breastfeed. If the baby weighs less than 1,500 gm you must refer the mother and baby urgently.

WHAT IS NEWBORN SCREENING? is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated.

Goal: to give all newborns a chance to live a normal life.

Currently, NBS tests for five disorders: 1. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency A condition where the body lacks the enzyme called G6PD. The deficiency may cause hemolytic anemia, when the body is exposed to oxidative substances found in certain drugs, foods and chemicals. Parents of G6PD-positive babies receive a list of these substances from their doctor.

2. Congenital Hypothyroidism This is a lack of thyroid hormone, which your baby needs to grow. Treatment is required within the first four weeks of a baby's life to prevent stunted physical growth and mental retardation. One out of 3,369 babies is at risk. 3. Congenital Adrenal Hyperplasia An endocrine disorder that causes severe salt loss, dehydration and abnormally high levels of male sex hormones. Left undetected and untreated, it can be fatal within seven to 14 days. One in 7,960 babies is at risk. 4. Galactosemia A condition in which babies cannot process the sugar present in milk (galactose). This leads to increased galactose levels in the body, which leads to liver and brain damage. It also causes cataracts to develop. One in 82,250 babies may be affected. 5. Phenylketonuria A condition where the body does not properly use the enzyme phenylalanine, which may lead to brain damage. One in 109,666 babies may be at risk.

How to administer NBS: Your baby will be pricked at the heel. Three drops of blood will be taken for testing.

(-) negative result- NORMAL (+) positive result- will require the baby to undergo further testing by a pediatrician. *Parents are oriented about their childs condition through the National Institutes of Health (at the Philippine General Hospital). Parents will be notified through mail and through their attending doctors about positive results, and will be required to undergo the orientation and further testing at the NIH. For Hearing impairment Babies are screened for hearing impairment with one of two tests that measure how the baby responds to sounds. These tests are done in the hospital newborn nursery, using either a tiny soft earphone or microphone that is placed in the babys ear. If either of these tests shows abnormal results, the baby needs more extensive hearing testing to see if he does have hearing loss. POST PARTUM CARE Lochia changes Time postpartum characteristics

________________________________________________ delivery-day 3 4-10 days 10-14 days * Signs of abnormal lochia Foul smell Excessive amount (any stage) Scant (during rubra stage) Return to rubra after serosa and/ or alba Large clots lochia rubra (red) lochia serosa (brownish to pink) lochia alba (white)

Immediate Care for the Newly Delivered Mother Observe for vaginal bleeding, first 6 hours Palpate the fundus Inspect the perineal pad Massage fundus only if the uterus becomes soft and saggy

General Physical Care After pains Nutritional Needs Rest and Sleep Early Ambulation Hygiene of Mother Bowel Elimination Urinary Elimination Mental Health

Special Physical Care Aspect Breast Care Care of the Perineum Abdominal support Post Natal Exercises

Maternal and Psychological Adaptation (Rubin) PHASE Taking in (1 2 days postpartum) CHARACTERISTICS of the MOTHER Passive Dependent Concerned with own needs Verbalizes delivery experience Strives for independence Strong anxiety element Maximal stage of learning readiness Mood swings Achieves interdependence Realistic on role transition Accepts baby as separate person New norms establish for self NURSING IMPLICATIONS Assist mother in meeting physical needs. Begin teaching to prepare for possible early discharge. Provide positive reinforcement of parenting abilities Assist mother in providing for her increased energy requirements Provide positive reinforcement as she identifies her roles with her support system Allow her to verbalize her new role.

Taking hold (3-10 days postpartum)

Letting go (10 days to 6 weeks postpartum)

PRIORITY NURSING DIAGNOSIS DURING THE POST PARTUM STAGE. 1.

DRUG STUDY
Drug Data Generic Name Oxytocin Trade Name Pitocin Content Synthetic oxytocin Pharmacologic Class Hormone Therapeutic Class Oxytocic Pregnancy category X Dosage Adults Induction of labor: initial dose not more than 0.5-2 milliunits/min by IV infusion. Increase the dose of no more than 1-2 milliunits/mion at 30- to 60-min intervals; Control of postpartum bleeding: IV Add 10-40 units to 1000mL of a nonhydrating diluent, infuse at a rate to control uterine atony. IM administer 10 units after delivery of placenta Treatment of incomplete abortion: IV infusion of 10 units of oxytocin with Mechanism of Action Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary; stimulates the uterus, especially the gravid uterus just before parturition, and causes myoepithelium of the lacteal glands to contract, which results In milk ejection in lactating mothers. Indication - Antepatum: to initiate or improve uterine contractions to achieve early vaginal delivery; stimulation or reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; second trimester abortion - Postpartum: To produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage. - lactation deficiency - Unlabeled use; To evaluate fetal distress (oxytocin challenge test), treatment off breast engorgement Contraindications Significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or ougmentation of labor when vaginal delivery is contraindicated, previous cesarean section, pregnancy (nasal) Use cautiously with renal impairment. Adverse Reaction CV: Cardiac arryhtsmias, PVCs, HPN, subarachnoid hemorrhage Fetal effects: Fetal bradycaria, neonatal jaundice, low Apgar scores GI: nausea, vomiting Nursing Responsibilities Before - Assess for significant cephalopelvic disproportion, unfavorable fetal positions or presentations, severe toxemia, uterine inertia, hypertonic uterine patterns, previous cesarean section - Assess fetal heart rate, uterine tone - Ensure fetal position and size and absence of complications.

GU: postpartum hemorrhage, uterine rupture, pelvic During hematoma, uterine - Infuse via constant infusion pump hypertonicity, spasm, tetanic to ensure accurate control of rate; contraction, rupture of the rate determined by uterine uterus with excessive dosage, or response; begin with 1-2mL/min hypersensitivity and increase at 16- to 60-min intervals Hypersensitivity: Anaphylactic Do not combine in solution with reactions fibrinolysin or heparin - Monitor maternal BP Other: Maternal and fetal - Monitor neonate for jaundice deaths when used to induce st nd - Discontinue drug and notify labor or in 1 or 2 stages of physician at any sign of labor; afibrinogemia; severe hypertensive emergency water intoxication with seizures and coma, maternal death. After - Educate client on the side effects of the medication and what to expect. - Document that drug has been given.

500mL physiologic saline solution @ 10-20 milliunits/min Availability Injection 10 units/mL

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 913 Methylergonovine maleate (methergine) is an ergot alkaloid that stimulates smooth muscle Brand name: Methylergonovine Maleate tissue. Because the smooth muscle of the Pharmacologic:ergot uterus is especially alkaloids sensitive to this drug ,it is used postpartally to Availability Tablets:200 stimulate the uterus to mcg (0.2 contract in order to mg).Injection: 200 mcg decrease blood loss by (0.2 mg)/ml in 1-ml clamping off uterine ampules. blood vessels and to promote the involution process .In addition the Route,Dosage,Frequency drug has vasoconstrictive Methergine has a rapid effect on all blood onset of action and may be vessels, especially the given orally or larger arteries. intramuscularly. Generic Name: Methergine Usually IM dose: 0.2 mg following expulsion of the placenta.The dose may be repeated every 2-4 hours if necessary. Usual oral dose: 0.2 mg every 4 hours (six Pregnancy, hepatic or renal disease, cardiac disease, hypertension or preeclampsia contraindicate this drugs use. Methylergonovine maleate must be used with caution during lactation. Hypertension,nausea,vomiting, headache,brandycardia,dizzines s,tinnitus,abdominal cramps, palpitations, dyspnea, chest pain and allergic reactions may be noted.
Monitor fundal height and

consistency and the amount and character of the lochia. Assess the blood pressure before and routinely throughout drug administration. Observe for adverse effects or symptoms of ergot toxicity(ergotism) such as nausea and vomiting,headache,muscle pain,cold or numb fingers and toes,chest pain and general weakness. Patient /Family Teaching Instruct patient to take medication as directed; do not skip or double up on missed doses. If a dose is missed, omit it and return to regular dose schedule. Advise patient that medication may cause menstrual-like cramps Caution patient to avoid smoking, because nicotine constricts blood vessels. Instruct patient to notify health

doses) hyoscine, ethylpermid, vit k and eye care prophylaxis."

care professional if infection develops, as this may cause increased sensitivity to the medication.

Brand Name: Buscopan Generic Name: HyoscineN-butylbromide Classification: Antispasm odics Pregnancy Category: C Availability: Tablet 10 mg,Ampule 20mg Route & Dosage Tablet Adult and child >6 y/o 1 to 2 tab TID-QID Ampule Colic Pain Adult and adolescent >12 y/o 1-2 amp IV/IM/SC several times daily. Maximum dose: 100mg/day Infant and young children 0.3-0.6 mg/kg/body weight by slow IV/IM/SC several times daily. Maximum dose: 1.5 mg/kg/body weight.

The mechanism of action of Buscopan is that it blocks the muscarinic receptors found on the smooth muscle walls which means its blocks the action of acetylcholine on the receptors found within the smooth muscle of the gastrointestinal and urinary tract and thus reduces the spasms and contractions. This relaxes the muscle and thus reduced the pain from the cramps and spasms.

Spasm in the genitourinary tract

Myasthenia gravies, megacolon, hypersensitivity to drug Spasm in the contents, narrow angle gastrointestinal tract glaucoma, prostate hypertrophy with urinary Spasm in the biliary tract retention, mechanical Colic stenosis in the GI tract, tachycardia. Cautious Use: Thyrotoxicosis, cardiac insufficiency, pyrexia, fructose intolerance.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Constipation Decreased sweating Mouth, skin, eye dryness Blurred feeling Bloating Dysuria Nausea or vomiting Lightheadedness Headache Weakness

Drug Interaction: 1. Potassium chloride 2. Metoclopramide 3. MAO inhibitors 4. Beta-agonists 5. Anticholinergics 6. Antacids 7. Droperidol

1. Take this drug 30 minutes to 1 hour before meals 2. Buscopan will potentiate the effect of alcohol and other CNS depressants. 3. Do not take antacids and antidiarrheal 2 to 3 hours prior to raking this drug. 4. It is not necessary to take the medication if you are not in pain. 5. Avoid driving or operating machinery after parenteral dose.

Generic Name:Vitamin K(Pytonadione) Brand name:AquaMephyton Classification:fat-soluble vitamins,Antifibrinolytic Agents Intramuscular injection is given in the vastus lateralis thigh muscle.A one time only prophylactic dose of 0.5 to 1 mg is given intramuscularly in the birthing area within 1 hour of birth. If mother receive anticoagulant during pregnancy, an additional dose may be ordered by the physician and is given 6-8 hours after the first injection,IM/subcutaneous concentration: 1 mg/0.5 ml(neonatal strength)can use 10 mg/ml concentration to minimize volume injected.

Is used in prophylaxis and treatment of hemorrhagic disease of the newborn. It promotes liver formation of the clotting factors II, VII, IX and X. At birth, the newborn does not have bacteria in the colon that necessary for synthesizing fat-soluble vitamin K. Therefore, the newborn may have deceased levels of prothrombin during the first 5 to 8 days of life reflected by a prolongation of prothrombin time.

Pain and edema may occur at injection site. Allergic reaction such as rash and urticaria,may also occur.

Document the giving of the

medication to newborn to prevent an accidental doubling of the dose. Observe for bleeding (usually occurs on second or third day). Bleeding may be seen as generalized ecchymoses or bleeding from umbilical cord, circumcision site, nose or gastrointestinal tract. Observe for jaundice and kernicterus,especially in preterm infants. Observe for signs of local inflammation. Apply pressure to the injection site to prevent further bleeding Protect drug from light. Give vitamin K before circumcision procedure