![]() The goal of this narrative review was to provide a synopsis of pertinent literature on calcium use in obstetrics to explore the potential benefit of calcium carbonate as a simple and low-cost intervention for prevention or treatment of labor dystocia. Clinical findings of uterine hyperstimulation include the following: ◯ Contraction frequency more often than every 2 min ◯ Contraction duration longer than 90 seconds ◯ Contraction intensity that results in pressures greater than 90 mm Hg as shown by IUPC ◯ Uterine resting tone greater than 20 mm Hg between contractions ◯ No relaxation of uterus between contraction - ◯ The nurse may initiate oxytocin 6 to 12 hr after administration of the prostaglandin.Anecdotally, there are attestations from clinicians of calcium carbonate being used successfully for laboring people experiencing labor dystocia. DISCONTINUE oxytocin if uterine hyperstimulation occurs.Increase oxytocin as prescribed until desired contraction pattern is obtained and then maintain the dose if there is ■ Contraction frequency of 2 to 3 min ■ Contraction duration of 60 to 90 seconds ■ Contraction intensity of 40 to 90 mm Hg on IUPC ■ Uterine resting tone of 10 to 15 mm Hg on IUPC ■ Cervical dilation of 1 cm/hr ■ Reassuring FHR between 110 to 160/min ◯ A Bishop score rating should be obtained prior to starting any labor induction protocol. ◯ Assess fluid intake and urinary output. ◯ Monitor FHR and contraction pattern every 15 min and with every change in dose. ◯ When oxytocin is administered, assessments include maternal blood pressure, pulse, and respirations every 30 to 60 min and with every change in dose. ![]() ◯ An intrauterine pressure catheter (IUPC) may be used to monitor frequency, duration, and intensity of contractions. Oxytocin should be connected "piggyback" to the main IV line and administered via an infusion pump. ◯ Use the infusion port closest to the client for administration. ◯ Prior to the administration of oxytocin, it is essential that the nurse confirm that the fetus is engaged in the birth canal at a minimum of station 0. Oxytocin stimulation can lead to hypertonic uterine contractions.Administered to augment or induce labor by increasing intensity and duration of contractions.Oxytocin is not administered for: hypertonic contractions. Induction of labor THERAPEUTIC INTENT: Used to augment labor and strengthen uterine contractions NURSING CONSIDERATIONS: Administer if prescribed to augment labor. ■ Prepare for actions to prevent respiratory or cardiac arrest ◯ Nifedipine should not be administered concurrent with magnesium sulfate,or concurrent or immediately following a beta2-adrenergic agonist. ■ Administer antidote calcium gluconate or calcium chloride. ■ Absence of patellar deep tendon reflexes ■ Urine output less than 30 mL/hr ■ Respirations less than 12/min ■ Decreased level of consciousness ■ Cardiac dysrhythmias ◯ If magnesium toxicity is suspected: ■ Immediately discontinue infusion. ◯ Monitor for signs of magnesium sulfate toxicity. ◯ Place the client on fluid restriction of 100 to 125 mL/hr,and maintain a urinary output of 30 mL/hr or greater. ◯ Monitor blood pressure, pulse, respiratory rate, deeptendon reflexes, level of consciousness, urinary output (indwelling urinary catheter for accuracy), presence of headache, visual disturbances, epigastric pain, uterine contractions, and fetal heart rate and activity. ◯ Inform the client that she can initially feel flushed, hot, and sedated with the magnesium sulfate bolus. Nursing Considerations ◯ Use an infusion control device to maintain a regular flow rate.Medication of choice for prophylaxis or treatment to lower blood pressure and depress the CNS.
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