McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 4 0 Drugs affecting the female reproductive system

tone to monitor effectiveness of the drug and the occurrence of adverse effects. ■ ■ Monitor the results of laboratory tests, including complete blood count, leucocyte count, haemoglobin and haematocrit, to monitor for excess bleeding , and urinalysis to monitor for potential infection or reaction to the procedure. Implementation with rationale ■ ■ Administer via route indicated, following the manufacturer’s directions for storage and preparation, to ensure safe and therapeutic use of the drug. ■ ■ Confirm the pregnancy gestation before administering the drug to ensure appropriate use of the drug. ■ ■ Confirm that termination or uterine evacuation is complete by assessing vaginal bleeding and passing of tissue in the vaginal blood to avoid potential bleeding problems; prepare for dilation and curettage if necessary to stop excessive blood loss . ■ ■ Monitor blood pressure frequently during and after administration to assess for adverse effects ; discontinue the drug if blood pressure rises dramatically. ■ ■ Monitor uterine tone and involution and the amount of bleeding during and for several days after use of the drug to ensure appropriate response to and recovery from the drug. ■ ■ Provide support and appropriate referrals to help the woman deal with the termination or fetal death. ■ ■ Provide teaching, including monitoring necessary during drug administration, comfort measures, signs and symptoms of adverse effects, measures to minimise or prevent adverse effects, danger signs and symptoms to report immediately, need for follow-up monitoring and evaluation and sources for support and referrals to enhance the person’s knowledge about drug therapy and to promote compliance. Evaluation ■ ■ Monitor woman’s response to the drug (evacuation of uterus). ■ ■ Monitor for adverse effects (GI upset, nausea, blood pressure changes, haemorrhage, uterine rupture). ■ ■ Evaluate the effectiveness of the teaching plan (woman can name drug, dosage, adverse effects to watch for and specific measures to avoid them). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen.

Prototype summary: Dinoprostone Indications: Evacuation of the uterus in the management of missed abortion or intrauterine fetal death; management of non-metastatic gestational trophoblastic disease; initiation of cervical ripening. Actions: Stimulates the myometrium of the pregnant uterus to contract, evacuating the contents of the uterus. Pharmacokinetics: Route Onset Peak Duration Intravaginal 10 mins 15 mins 2–3 hours T 1/2 : 5 to 10 hours, with tissue metabolism and excretion in the urine. Adverse effects: Headache, paraesthesias, hypotension, vomiting, diarrhoea, nausea, uterine rupture, uterine or vaginal pain, chills, diaphoresis, backache, fever. ■ ■ Assess for contraindications or cautions: history of allergy to any prostaglandin preparation to avoid hypersensitivity reactions ; active PID, which could be exacerbated by the increased uterine activity ; cardiac, hepatic, pulmonary or renal disease problems, which could be exacerbated by the effects of the drug ; history of asthma, which predisposes the woman to hypersensitivity reactions ; hypotension, hypertension and epilepsy, which require cautious use of the drug ; and scarred uterus or acute vaginitis, which could be exacerbated by the strong uterine contractions. ■ ■ Perform a complete physical assessment before beginning therapy to establish baseline status and during therapy to determine drug effectiveness and evaluate for any potential adverse effects. ■ ■ Confirm date of last menstrual period and estimated duration of pregnancy to ensure appropriate use of the drug. ■ ■ Assess vital signs, including skin and lesions; orientation and affect; and blood pressure, pulse and respiration; and auscultate lung sounds, to monitor for vascular effects, including bleeding and hypersensitivity reactions. ■ ■ Assist with or complete a pelvic examination, observe for vaginal discharge and evaluate uterine Care considerations for women receiving prostaglandins Assessment: History and examination