NURS 131 Pitocin and Sildenafil

jasmine's version from 2016-04-25 22:30

Section 1

Question Answer
Pitocin (Oxytocin injection) Hormones; Causes uterus to contract; Used to induce labor or strengthen labor contractions during childbirth, and to control bleeding after childbirth; Also used to stimulate uterine contractions in a woman with an incomplete or threatened miscarriage
Pitocin actions Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor; Has vasopressor and anti-diuretic effects
Pitocin therapeutic effects Induction of labor; Control of postpartum bleeding
Metabolism and excretion of Pitocin Rapidly metabolized by liver and kidneys
Contraindications of Pitocin Hypersensitivity; anticipated nonvaginal delivery
Use Pitocin cautiously in First and second stages of labor; slow infusion over 24 hr has caused water intoxication with seizure and coma or maternal death due to oxytocin’s anti-diuretic effect
Adverse/Side effects of Pitocin For IV use only: Coma, seizures, increase uterine motility, painful contractions (maternal); intracranial hemorrhage, asphyxia (fetal)
Drug-drug interactions of Pitocin Severe hypertension may occur if oxytocin follows administration of vasopressors
Route administration of Pitocin IV (induction/stimulation of labor); IV and IM (postpartum hemorrhage); IV (incomplete/inevitable abortion)
Nursing assessment of Pitocin Assess fetal maturity, presentation, and pelvic adequacy prior to administration for induction of labor; assess character, frequency, and duration of uterine contractions, resting uterine tone, and fetal heart rate frequently throughout administration; monitor maternal BP and pulse frequently and fetal heart rate continuously throughout administration; Monitor patient for signs and symptoms (drowsiness, listlessness, confusion, headache, anuria) and notify physician or other health care professional if occur; lab test considerations: monitor maternal electrolytes; water retention may result in hypochloremia or hyponatremia
Nursing implementation of Pitocin Do not administer oxytocin simultaneously by more than one route
Route of administration of Pitocin IV; continuous infusion
Patient/family teaching of Pitocin Advise patient to expect contractions similar to menstrual cramps after administration has started
Evaluation/Desired outcomes of Pitocin Onset of effective contractions; increase in uterine tone; reduction in postpartum bleeding
Potential nursing diagnoses of Pitocin Deficient knowledge, related to medication regimen (patient/family teaching)

Section 2

Question Answer
Sildenafil (Viagra) Erectile dysfunction agents; Vasodilators; Relaxes muscles found in the walls of blood vessels and increases blood flow to particular areas of the body; Used to treat erectile dysfunction in men
Sildenafil actions Enhances effects of nitric oxide released during sexual stimulation; Nitric oxide activates guanylate cyclase, which produces increased levels of cyclic guanosine monophosphate (cGMP); cGMP produces smooth muscle relaxation of the corpus cavernosum, which promotes increased blood flow and subsequent erection, and also leads to vasodilation of the pulmonary vasculature. It blocks the enzyme phosphodiesterase type 5 (PDE5); PDE5 inactivates cGMP
Sildenafil therapeutic effects Enhanced blood flow to the corpus cavernosum and erection sufficient to allow sexual intercourse; Requires sexual stimulation
Metabolism and excretion of Sildenafil Mostly metabolized by the liver (by P450 3A4 enzyme system); Metabolites excreted mostly (80 percent) in feces and 13 percent in urine
Half-life of Sildenafil 4 hr
Contraindications of Sildenafil Hypersensitivity; OB, Pedi: newborns, women children; Pedi: revatio: chronic use not recommended for pulmonary hypertension due to lack of efficacy and increase risk of death
Adverse/Side effects of SildenafilHeadache, myocardial infarction, sudden death, dyspepsia (ingestion), flushing
Drug-drug interactions of SildenafilConcurrent use of nitrates may cause a serious decrease in blood pressure; If renal impairment, decrease dose and no more than once daily
Nursing assessment of Sildenafil Determine erectile dysfunction before administration; It has no effect in the absence of sexual stimulation
Patent/family teaching of Sildenafil Instruct patient to take sildenafil as directed; Advise patient that not indicated for use in women; Caution patient not to take concurrently with alpha-adrenergic blockers (unless on a stable dose) or nitrates; If chest pain occurs, instruct patient to seek immediate medical attention; Instruct patient to notify health care professional promptly if erection lasts longer than 4 hr or if experience sudden or decreased vision loss in 1 or both eyes or loss or decrease in hearing, ringing in the ears, or dizziness; Inform patient that it offers no protection against sexually transmitted diseases
Evaluation/Desired outcomes of Sildenafil Male erection sufficient to allow intercourse; Increased exercise tolerance
Potential nursing diagnoses of Sildenafil Sexual dysfunction (indications); Risk for activity intolerance (indications)