Concept: Comfort
Name: Oxytocin
Classification: Oxytocic agent
Therapeutic Use
Mechanism of Action:
cephalopelvic disproportion, fetal intolerance of
labor, hypersensitivity, anticipated nonvaginal
delivery; intranasal spray (contraindicated in
Induce or augment labor
Stimulates uterine smooth muscle,
producing uterine contractions
slow infusion over 24 hr has caused water
intoxication with seizure and coma or maternal
death due to oxytocin's antidiuretic effect
vasopressor and antidiuretic effects
Patient Problems
Pain, discomfort, reduced
functional ability
Side Effects/Adverse Rxns:
↑ uterine mo lity, painful contrac ons, water intoxication (nausea, vomiting, hypotension, tachycardia, and cardiac arrhythmias)
LT: Coma, seizures, maternal intracranial hemorrhage (bleeding inside skull/brain), asphyxia, fetal jaundice,
Nursing Implications/ Teaching:
Herbal Effects: Black cohosh, cottonroot, squaw vine, and cinnamon can have a synergistic (combined, greater)
effect to oxytocin
Monitor vital signs every 30‐60 minutes with every dosage change.
Monitor uterine contractions and FHR (maternal fetal monitoring).
Confirm gestation.
Monitor FHR for decelerations below baseline during contractions.
Have tocolytic‐terbutaline and O2 available.
Monitor patient intake and output.
Maintain the patient in left lateral recumbent to promote placental infusion.
Monitor for signs of uterine rupture (FHR decelerations, sudden increased pain, loss of uterine contractions,
hemorrhage, and rapidly developing hypovolemic shock) or placental abruption.
Use IV pump to administer oxytocin drip
Drug is given intravenously, and the dosage is adjusted in response to the uterine contraction pattern
Advise patient to expect contractions like menstrual cramps after administration has started
Name: Clomiphene
Concept: Hormonal Regulation
Classification: ovulation inducer
Therapeutic Use
Mechanism of Action:
Pregnancy, undiagnosed vaginal bleeding,
depression, fibroids, hepatic dysfunction,
thrombophlebitis, primary pituitary or
ovarian failure
To stimulate ovarian follicle growth to
induce ovulation
Selective estrogen regulator
modulator increasing estrogen
Patient Problems
Discomfort, patient teaching, anxiety,
reduced sexual expression, grieving
Stimulates release of follicle‐
stimulating hormone and
luteinizing hormone
Side Effects/Adverse Rxns:
Hot flashes, ovarian cyst formation, ovarian enlargement, heavier menses, fatigue, dizziness, vomiting, nausea, headache,
abdominal bloating, stomach or pelvic pain, photophobia, diplopia, and decreased visual acuity
fetal/neonatal abnormalities: delayed development, mental retardation, abnormal bone development, tissue malformation, abnormal
organ development dwarfism, chromosomal disorders, and neural tube defects.
LT: Ovarian hyperstimulation syndrome (OHSS; acute abdominal pain and distension, nausea, vomiting, diarrhea, and weight
gain, gross ovarian enlargement, ascites, dyspnea, oliguria, and pleural effusion)
Nursing Implications/ Teaching:
Teach patient normal physiological process of conception.
Advise patient on sexual techniques that enhance fertilization with pillow under females’ hips and maintain
position a minimum of 30 minutes after intercourse.
Initiate drug treatment regimens as prescribed by the provider.
Provide the patient and her partner psychological counseling and support.
Patient to report adverse effects, abdominal pain, or visual disturbances.
Advise patient to take medication at the same time every day and if a dose is missed to notify provider.
Advise patient that treatment increases the chance of multiple births.
Name: Conjugated
Concept: Hormonal Regulation
Classification: Estrogen
Therapeutic Use
Mechanism of Action:
vaginal bleeding, pregnancy, lactation, severe liver
disease, venous thrombosis, personal history of breast
Moderate to severe
vasomotor symptoms of
menopause and vaginal
Develops and maintains female
genital system, breast, and
secondary sex characteristics;
increases synthesis of protein
Caution: Cardiovascular disease, severe renal disease,
diabetes mellitus
Absolute contraindications in myocardial infarction, new
primary malignancy, stroke, thromboembolism, and
Patient Problems
Discomfort, patient teaching,
Side Effects/Adverse Rxns:
Nausea, vomiting, fluid retention, breast tenderness, leg cramps, breakthrough bleeding, chloasma, Jaundice,
thromboembolic disorders, depression, hypercalcemia, gallbladder disease
LT: Thromboembolism, CVA (cerebrovascular accident), PE, MI, endometrial cancer, anaphylaxis, angioedema
Nursing Implications/ Teaching:
Patient will choose hormone therapy (HT) that works best for them.
Patient will verbalize dosing schedule, risks, benefits, and alternative of their treatment.
Breast and pelvic exam prior to treatment.
Fan, cool liquids, and decrease caffeine and spicy foods may help symptoms.
Use water‐based lubricant as needed.
Take med with food to decrease GI distress.
Vaginal bleeding may occur during first 3‐6 months of therapy.
To prevent osteoporosis, encourage weight‐bearing exercise, diet high fiber, vegetables, fruits, and plant protein, low in animal
protein and sugar.
Boxed warning—hormone therapy should be used only for the treatment of menopausal symptoms, at the lowest dose possible, for
the shortest duration possible, usually less than 5 years
report signs and symptoms of fluid retention (swelling of ankles and feet, weight gain), thromboembolic disorders (pain,
swelling, tenderness in extremities; headache; chest pain; blurred vision), depression, hepatic dysfunction (yellowed skin or eyes,
pruritus, dark urine, light‐colored stools), or abnormal vaginal bleeding to health care professional
report adverse effects such as abdominal pain or visual disturbances to the infertility specialist at once and to be cautious with tasks
that require alertness
Concept: (Here)
Name: Testosterone
Classification: Androgen CSS III
Therapeutic Use
Mechanism of Action:
cottonseed oil, pregnancy, breastfeeding, male breast
cancer, and prostate cancer, history of MI,
Androgen replacement therapy in
treatment of delayed male puberty, male
hypogonadism, replacement therapy for
testicular failure in adult males
Bind to androgen
receptors to control
development and
maintenance of sexual
processes, accessory
sexual organs, cell
metabolism, and
bone/muscle growth.
Caution: Prostate cancer risk, benign prostatic
hyperplasia, older adults, renal and/or hepatic
impairment, risk of hypercalcemia, cardiovascular
disease, heart failure, hyperlipidemia, diabetes,
pulmonary disease, obesity, sleep apnea,
polycythemia, and male patients trying to conceive
Patient Problems
Sexual expression, self‐concept, weight
gain, decreased self‐esteem
Side Effects/Adverse Rxns:
Priapism (painful, continuous erection), gynecomastia (mammary glad enlargement), urgent urination, halt of spermatogenesis,
abdominal pain, nausea, insomnia, diarrhea or constipation, hives or redness at the injection site, increased salivation, mouth
soreness, and increased or decreased sexual desire; hypercalcemia, virilization (acne, oily skin, face hair in females); Females –
menstrual irregularities or amenorrhea, suppressed ovulation or lactation, baldness or increased hair growth (hirsutism), hypertrophy
of clitoris
LT: MI, stroke, venous thromboembolism
Nursing Implications/ Teaching:
Baseline VS. Drug and health history. Assess ordered lab work.
Assess skeletal x‐ray of hand and wrist in children on androgen therapy every 6 months.
Collaborate with patient and family on proper administration.
Advise patient that an intermittent approach to therapy allows for monitoring of endocrine status.
Encourage patient to monitor muscle strength.
Urge men undergoing androgen therapy to report priapism promptly so drug dosage can be reduced to avoid
subsequent erectile dysfunction.
Instruct men to report decreased urinary stream promptly so they can be evaluated for prostatic hypertrophy.
Monitor serum calcium levels and encourage patient to increase fluid intake to 2 L per day or more to avoid
kidney stone formation.