ANGELES UNIVERSITY FOUNDATION

Angeles City
College of Nursing

NURSING CARE MANAGEMENT 0107- RLE

MATERNAL AND CHILD HEALTH NURSING
FIRST SEMESTER A.Y. 2020 – 2021

POSTPARTUM CARE ACTIVITY

DRUG STUDY
Submitted By:
Dimaunahan, John Paul L.
BSN II – A
Cefuroxime
Generic Name: Cefuroxime
Brand Name:
• Ceftin
• Zinacef
• Kefurox
Drug Classification:

• Anti-infective
• Cephalosporin (2nd generation)
• cephalosporin antibiotic.

Mechanism of Action:

Inhibits bacterial cell wall synthesis, renders cell wall osmotically unstable, leads to cell
death by binding to cell wall membrane. It simply fights bacteria in your body by stopping
its growth. May also be used to prevent infection from certain surgeries

Stock Dosage:

Injection, Powder for Reconstitution: 750 mg, 1.5 g. Injection, Solution: 1.5 g/50 mL. Oral
Suspension (Ceftin): 125 mg/5 mL, 250 mg/5 mL. Tablets (Ceftin): 250 mg, 500 mg

Indication:

Treatment of susceptible infections due to group B streptococci, pneumococci,

staphylococci, H. influenzae, E. coli, Enterobacter, Klebsiella, including acute/chronic
bronchitis, gonorrhea, impetigo, early Lyme disease, otitis media, pharyngitis/tonsillitis,
sinusitis, skin/skin structure, UTI, perioperative prophylaxis.

Contraindications:

Hypersensitivity to cephalosporins or related antibiotics; seizures Precautions:

Pregnancy, breastfeeding, children, GI/renal disease, diabetes mellitus, coagulopathy,
pseudomembranous colitis.
Side effects/adverse reactions:

Frequent: Discomfort with IM administration, oral candidiasis (thrush), mild diarrhea, mild
abdominal cramping, vaginal candidiasis. Occasional: Nausea, serum sickness–like
reaction (fever, joint pain; usually occurs after second course of therapy and resolves
after drug is discontinued). Rare: Allergic reaction (rash, pruritus, urticaria),
thrombophlebitis (pain, redness, swelling at injection site)

Nursing interventions:

• Determine history of hypersensitivity reactions to cephalosporins, penicillins, and

history of allergies, particularly to drugs, before therapy is initiated.
• Lab tests: Perform culture and sensitivity tests before initiation of therapy and
periodically during therapy if indicated. Therapy may be instituted pending test
results. Monitor periodically BUN and creatinine clearance.
• Inspect IM and IV injection sites frequently for signs of phlebitis.
• Report onset of loose stools or diarrhea. Although pseudomembranous colitis
rarely occurs, this potentially life-threatening complication should be ruled out as
the cause of diarrhea during and after antibiotic therapy.
• Monitor for manifestations of hypersensitivity. Discontinue drug and report their
appearance promptly.
• Monitor I&O rates and pattern: Especially important in severely ill patients receiving
high doses. Report any significant changes.
• Remind patient to take the full routine course, do not stop if symptoms weaken.
• Consult a doctor if severe diarrhea with blood, pus, or mucus; rash; difficulty in
breathing; fatigue; unusual bruising, itching or irritation occurs
• · Inform patient on side effects such as upset stomach / diarrhea
Metronidazole
Generic Name: Metronidazole
Brand Name:
• Anerobizol.
• Antizoal.
• Dazomet.
• Flagyl.
• Medgyl.
• Medgyl IV.
• Metrazol.
Drug Classification:

• Nitroimidazole derivative.
• Antibacterial
• Antiprotozoal.

Mechanism of Action:

Direct-acting amebicide/trichomonacide binds and disrupts DNA structure, thereby

inhibiting bacterial nucleic acid synthesis

Stock Dosage:

Capsules: 375 mg. Injection (Infusion): 500 mg/100 mL. Suspension, Oral: 50 mg/mL,
100 mg/mL. Tablets (Flagyl): 250 mg, 500 mg. Topical Cream: 0.75% (MetroCream), 1%
(Noritate). Topical Gel (MetroGel): 0.75%, 1%. Vaginal Gel (MetroGel-Vaginal,
Vandazole): 0.75%. Tablets (Extended-Release): 750 mg.

Indication:

Elective hysterectomy or vaginal repair, and emergency appendectomy. IV metronidazole

is used for the treatment of serious infections caused by susceptible anaerobic bacteria
in intraabdominal infections, skin infections, gynecologic infections, septicemia, and for
both pre- and postoperative prophylaxis, bacterial vaginosis. Topical: Rosacea.
Contraindications:

Hypersensitivity to metronidazole. Pregnancy (first trimester with trichomoniasis), use of

disulfiram within 2 wks, use of alcohol during therapy or within 3 days of discontinuing
Metronidazole. Cautions: Blood dyscrasias, severe hepatic dysfunction, end-stage renal
disease, seizure disorder, HF, other sodium-retaining states, elderly

Side effects/adverse reactions:

Frequent: Systemic: Anorexia, nausea, dry mouth, metallic taste. Vaginal: Symptomatic
cervicitis/vaginitis, abdominal cramps, uterine pain. Occasional: Systemic: Diarrhea,
constipation, vomiting, dizziness, erythematous rash, urticaria, reddish-brown urine.
Topical: Transient erythema, mild dryness, burning, irritation, stinging, tearing when
applied too close to eyes. Vaginal: Vaginal, perineal, vulvar itching; vulvar swelling. Rare:
Mild, transient leukopenia; thrombophlebitis with IV therapy.

Nursing interventions:

• Discontinue therapy immediately if symptoms of CNS toxicity develop. Monitor

especially for seizures and peripheral neuropathy (e.g., numbness and
paresthesia of extremities).
• Obtain total and differential WBC counts before, during, and after therapy,
especially if a second course is necessary.
• Monitor for S&S of sodium retention, especially in patients on corticosteroid
therapy or with a history of CHF.
• Monitor patients on lithium for elevated lithium levels.
• Report appearance of candidiasis or its becoming more prominent with therapy to
physician promptly.
• Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been
eliminated.
• Inform client that urine may appear dark or reddish brown (especially with higher
than recommended doses). This appears to have no clinical significance.
 • Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue,
glossitis, stomatitis; vaginitis, curd-like, milky vaginal discharge; proctitis.
Treatment with a candidacidal agent may be indicated.
• Do not breast feed while taking this drug.

Ferrous Sulfate:

Generic Name: Ferrous Sulfate

Brand Name:

• Anemifer
• Beefer Plus
• Brisofer
• Feosol
• Ferglobin
• Ferosal
• Hemovit
• Rhea Ferrous Sulfate
• Sorbifer Durules
• United Home Fersulfate Iron

Drug Classification:

• Oral iron supplement

• Enzymatic mineral
• Iron preparation.
• Hemantinic

Mechanism of Action:

Essential component in formation of Hgb, myoglobin, enzymes. Promotes effective

erythropoiesis and transport, utilization of oxygen. Therapeutic Effect: Prevents iron
deficiency.
Stock Dosage:

Oral Solution: 75 mg/mL (15 mg/mL elemental iron). Tablets: 325 mg (65 mg elemental
iron). Syrup: 300 mg/5 mL (60 mg elemental iron per 5 mL). Tablets (Timed-Release):
160 mg (50 mg elemental iron).

Indication:

The drug can maintain the hemoglobin level of the mother. Treatment and prevention of
iron deficiency anemia and for nutritional supplementation purposes.

Contraindications:

Sideroblastic anemia, thalassemia, hemosiderosis/hemochromatosis Precautions:

Pregnancy, anemia (long term), ulcerative colitis/regional enteritis, peptic ulcer disease,
hemolytic anemia, cirrhosis, sulfite sensitivity

Side effects/adverse reactions:

GI: Nausea, constipation, epigastric pain, black and red tarry stools, vomiting, diarrhea
INTEG: Temporarily discolored tooth enamel and eyes

Nursing interventions:

• Explain to client that be aware that iron preparations cause dark green or black
stools.
• Advise to report constipation or diarrhea to physician
• Provide teaching about ascorbic acid increases absorption of iron. Consuming
citrus fruit or tomato juice with iron preparation (except the elixir) may increase its
absorption.
• Monitor hemoglobin, hematocrit and iron levels

Mefenamic Acid
Generic Name: Mefenamic Acid
Brand Name:
• Dolfenal [ Westmont ]
• Fenamax [ CSPC Ouyi Pharma ]
 • Gisfen [ S V More ]
• Mefenax [ One Pharma ]
• Pharex Mefenamic Acid [ Pascual ]
• Ponstan/Ponstan SF [ Pfizer ]
• RiteMED Mefenamic Acid [ RiteMED ]
Drug Classification:

• central nervous system agent - affect the central nervous system (CNS)
• Analgesic - relieves pain
• NSAID - nonsteroidal anti-inflammatory drugs - used to treat
inflammation; mild to moderate pain; and fever
• Antipyretic – prevent or relieve fever

Mechanism of Action:

Mefenamic acid has analgesic, anti-inflammatory, and antipyretic properties. The

mechanism of action of mefenamic acid, like that of other NSAIDs, is not completely
understood but involves inhibition of cyclooxygenase (COX-1 and COX-2).Mefenamic
acid is a potent inhibitor of prostaglandin synthesis in vitro.

Stock Dosage:

Capsule: 250mg Acute Pain Initial 500 mg PO once, then 250 mg PO q6hr PRN usually
not to exceed 7 days

Indication:

Mefenamic acid has analgesic, anti-inflammatory, and antipyretic properties which can
be used for the short-term treatment of mild to moderate pain from various conditions.

Contraindications:

Hypersensitivity to drug, GI inflammation, or ulceration, History of kidney or liver disease

blood dyscrasias, Asthma, diabetes mellitus and Hypersensitivity to aspirin.

Side effects/adverse reactions:

CNS: Drowsiness, insomnia, dizziness, nervousness, confusion, headache.

GI: Severe diarrhea, ulceration, and bleeding; nausea, vomiting, abdominal cramps,
flatus, constipation, hepatic toxicity.

Hematologic: Prolonged prothrombin time, severe autoimmune hemolytic anemia (long-

term use), leukopenia, eosinophilia, agranulocytosis, thrombocytopenic purpura,
megaloblastic anemia, pancytopenia, bone marrow hypoplasia.

Urogenital: Nephrotoxicity, dysuria, albuminuria, hematuria, elevation of BUN.

Skin: Urticaria, rash, facial edema.

Spec Senses: Eye irritation, loss of color vision (reversible), blurred vision, ear pain.

Body: Perspiration.

CV: Palpitation.

Respiratory: Dyspnea; acute exacerbation of asthma; bronchoconstriction (in patients

sensitive to aspirin).

Nursing interventions:

• Test for CBC, Hct & Hgb, and Kidney function tests
• Assess patients who develop severe diarrhea and vomiting for dehydration and
electrolyte imbalance
• If diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur inform
patient to discontinue, contact physician and do not use again.
• Monitor glucose in blood for loss of glycemic control if patient is diabetic
• If GI discomfort, sore throat, fever and malaise persist, immediately notify
physician.
• Inform patient of possible side effects
Methergine
Generic Name: methylergonovine
Brand Name:
• Methergine
• Ergon
• Mergot
• Ergojen
Drug Classification:

• Ergot alkaloid
• Oxytoxic agent
• Uterine stimulant.

Mechanism of Action:

Stimulates uterine, vascular, and smooth muscle, thereby causing contractions;

decreases bleeding; arterial vasoconstriction. Helps control bleeding and other problems
in uterine after childbirth

Stock Dosage:

Adult: PO 200 mcg tid-qid × ≤7 days; IM/IV 200 mcg q2-4hr × 1-5 doses Available forms:
Inj 200 mcg/mL; tablets 200 mcg

Indication:

Management of uterine atony, hemorrhage and subinvolution of uterus following delivery

of placenta. Control uterine hemorrhage following delivery of anterior shoulder in second
stage of labor.

Contraindications:

Hypersensitivity to methylergonovine. Hypertension, pregnancy, toxemia. Cautions:

Renal/hepatic impairment, coronary artery disease, pts at risk for coronary artery disease
(diabetes, obesity, smoking, hypercholesterolemia), concurrent use with CYP3A4
inhibitors (e.g., protease inhibitors), occlusive peripheral vascular disease, sepsis,
second stage of labor.
Side effects/adverse reactions:

Frequent: Nausea, uterine cramping, vomiting. Occasional: Abdominal pain, diarrhea,

dizziness, diaphoresis, tinnitus, bradycardia, chest pain. Rare: Allergic reaction (rash,
pruritus), dyspnea, severe or sudden hypertension.

Nursing interventions:

• Inform patient that hypertension, cramps, nausea, vomiting, dyspnea may occur
• Monitor BP, heart rate, uterine response during and after treatment until partum
period is stabilized
• Assess calcium levels to determine effectiveness (↓ with hypocalcemia)
• Monitor uterine bleeding and notify the physician is there are any changes
• Inform patient on possible side effects.

Oxytocin
Generic Name: Oxytocin
Brand Name:
• Pitocin
• Evatocin
• Lavoxin
• Popicin
Drug Classification:

• Uterine smooth muscle stimulant.

• Oxytocic agent.

Mechanism of Action:

Activates receptors that trigger increase in intracellular calcium levels in uterine myofibrils;
increases prostaglandin production. Therapeutic Effect: Stimulates uterine contraction;
Acts directly on myofibrils, thereby producing uterine contraction; stimulates milk ejection
by the breast; vasoactive antidiuretic effect

Stock Dosage:

Injection (Pitocin): 10 units/mL. Injection, Solution: 30 units/500 mL.

Indication:

Antepartum: Induction of labor in pts with medical indication (e.g., at or near term), to
stimulate reinforcement of labor, as adjunct in managing incomplete or inevitable
abortion. Postpartum: To produce uterine contractions during third stage of labor and to
control postpartum bleeding/hemorrhage.

Contraindications:

Hypersensitivity to oxytocin. Adequate uterine activity that fails to progress, cephalopelvic

disproportion, fetal distress without imminent delivery, grand multiparity, hyperactive or
hypertonic uterus, obstetric emergencies that favor surgical intervention, prematurity,
unengaged fetal head, unfavorable fetal position/presentation, when vaginal delivery is
contraindicated (e.g., active genital herpes infection, invasive cervical cancer, placenta
previa, cord presentation). Cautions: Induction of labor should be for medical, not
elective, reasons. Generally, not recommended in fetal distress, hydramnios, partial
placental previa, predisposition to uterine rupture.

Side effects/adverse reactions:

Occasional: Tachycardia, premature ventricular contractions, hypotension, nausea,

vomiting. Rare: Nasal: Lacrimation/tearing, nasal irritation, rhinorrhea, unexpected
uterine bleeding/contractions.

Nursing interventions:

• Assess baselines for vital signs.

• Determine frequency, duration, strength of contractions.
• To report increased blood loss, abdominal cramps, fever, foul-smelling lochia,
nausea, blurred vision, itching, swelling
 • Inform client that contractions will be similar to menstrual cramps, gradually
increasing in intensity

REFERENCE:

Skidmore-Roth, L. (2019). Mosby's 2019 Nursing Drug Reference. St. Louis, MO:
Elsevier.

Kizior, R. J., & Hodgson, K. J. (2019). Saunders nursing drug handbook 2019. St. Louis,
MO: Elsevier.

Metronidazole Side Effects: Common, Severe, Long Term. (n.d.). Retrieved October 26,
2020, from https://www.drugs.com/sfx/metronidazole-side-effects.html

RNspeak. (2020, September 08). Mefenamic Acid (Ponstan) Drug Study. Retrieved
October 27, 2020, from https://rnspeak.com/mefenamic-acid-ponstan-drug-study