12.06 Uterine Stimulants (Oxytocin, Pitocin)

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Overview

  1. Oxytocin is a naturally occurring hormone that is released during labor and when breastfeeding
  2. Stimulates uterine contractions and increases intensity, strength, and duration of contractions
  3. Synthetic form given as a continuous infusion IV for labor induction or in postpartum hemorrhage

Nursing Points

General

  1. Uses
    1. Induce/augment labor
    2. Help control PPH
    3. Incomplete abortions
  2. Causes extremely painful uterine contractions

Assessment

  1. Monitoring
    1. Frequent monitoring of mom
      1. Contractions
        1. Monitor and chart frequency, duration, intensity
        2. Watch for hypertonic contraction – a single contraction lasting >2 min or >5 contractions in 10 min
      2. Frequent I&O
        1. Side effect is water retention
    2. Frequent fetal monitoring
      1. Continuous fetal monitoring
    3. Assess for uterine atony
      1. Give pitocin to stimulate contractions

Therapeutic Management

  1. Order set – base monitoring, titrations, and interventions based up on this protocol
  2. If the baby has non reassuring fetal heart tones
    1. STOP infusion
    2. Turn mom on left side
    3. O2
    4. Assess baby and mom to see if changes occurred
    5. Notify MD

Nursing Concepts

  1. Pharmacology
  2. Safety

Patient Education

  1. Expect to feel pain/contractions
  2. Purpose of medication
  3. Plan of care
    1. Epidural
    2. Monitoring

Reference Links

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Video Transcript

In this lesson I will explain uterine stimulants and your role using them in patient care.

Ok so first a uterine stimulant is just something that stimulates the uterus. The drug that does this is Oxytocin or pitocin. So this is a hormone that women naturally release during labor and during breastfeeding. So what is it going to do? It is going to stimulate uterine contractions and increases intensity, strength, and duration of contractions and it can also be given synthetically through the IV to help progress labor and move it along, for inducing labor or in postpartum hemorrhage. For use in a postpartum hemorrhage it is going to contract the uterus and cause the uterus to firm up and stop bleeding. When a uterus is boggy instead of firm it bleeds. Refer to the postpartum hemorrhage lesson for more on this.

Assessment is going to be a lot of monitoring. The mother will be monitored frequently for contractions. So the frequency, duration, and intensity of contractions. We want to assess for hypertonic contractions which are either a single contraction lasting 2 minutes or more or 5 or more contractions in 10 minutes. Intake and output need to be monitored because a side effect of oxytocin is water retention. It acts like the antidiuretic hormone. Now the fetus also needs monitoring. So continuous monitoring of fetal heart tones to ensure the fetus is tolerating the contractions. After delivery the uterus will be assessed frequently and watched for atony. This is the most frequent cause of postpartum hemorrhage so if atony occurs we will give pitocin to stimulate contractions. Management is two big things. There is typically an order set and pitocin will be titrated based on that and your monitoring. If during monitoring you find the baby has non reassuring fetal heart tones so isn’t tolerating the contractions you must STOP the infusion and turn mom on side, give oxygen, and notify the provider.
Education will be that she will feel pain and contractions that will intensify. We want her to know that the purpose of the medication is either to help progress the labor or to stop bleeding in uterine atony. And what is your plan of care so an epidural if she wants because of the contraction pain that is going to be caused and how often we will be monitoring.
Pharmacology and safety are the concepts because this medication requires a lot of monitoring to ensure the safety of the fetus with the contractions and the mom when used for uterine atony.

Let’s look at our review. Oxytocin or pitocin are used to stimulate the uterus to contract. It is used in labor induction or to progress labor and also in postpartum hemorrhage to contract the uterus and slow bleeding.

Make sure you check out the resources attached to this lesson and review the key points. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 6

The nurse is caring for a postpartum client who delivered three hours ago. The nurse assesses the client and notes that she has a boggy uterus. Which of the following is the priority action for the nurse?

  • Question 2 of 6

The nurse is caring for a client who is experiencing hypotonic labor. What do you expect for her plan of care?

  • Question 3 of 6

The nurse is caring for a client whose contractions are two minutes apart and the fetus is having late decelerations. Which of the following is an appropriate action for the nurse to take? Select all that apply.

  • Question 4 of 6

A client who had a prolonged labor and was given pitocin during this process should be monitored for what adverse effects? Select all that apply.

  • Question 5 of 6

A client who is 40 weeks pregnant will have labor induced. Which of the following medications does the nurse anticipate giving to this client to initiate this process?

  • Question 6 of 6

Which of the following is a contraindication for the use of oxytocin? Select all that apply.

Module 0 – OB Course Introduction

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