Concept: Comfort Name: Oxytocin Classification: Oxytocic agent Contraindications Therapeutic Use Mechanism of Action: cephalopelvic disproportion, fetal intolerance of labor, hypersensitivity, anticipated nonvaginal delivery; intranasal spray (contraindicated in pregnancy) Induce or augment labor contractions 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, hypoxia 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 Citrate Classification: ovulation inducer Contraindications 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 levels 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 Estrogens Classification: Estrogen Contraindications Therapeutic Use Mechanism of Action: vaginal bleeding, pregnancy, lactation, severe liver disease, venous thrombosis, personal history of breast cancer Moderate to severe vasomotor symptoms of menopause and vaginal dryness/atrophy 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 dementia Patient Problems Discomfort, patient teaching, anxiety 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 Contraindications 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.