Documenti di Didattica
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INDEX
SN
O
CONTENT
1
2
INTRODUCTION
2
STANDING ORDERS
2
3
DEFINITION
3
OBJECTIVES
3
USES
STANDING ORDER FOR A
4
MIDWIFE DURING:ANTEPARTUM
6
INTRAPARTUM
8
POSTPARTUM
11
LIST OF LIFE SAVING DRUGS AND ITS 15
RECOMMENDATION
15
CONCLUSION
18
RESEARCH ABSTRACTS
BIBILOGRAPHY
3
4
5
6
PAGE
NO
TEACHER
S
SIGNATU
RE
specific client with identified clinical problem. Standing orders are approved
and signed by the physician in charge of care before their implementation.
They are commonly found in critical care setting and other specialized
practice setting where clients needs can change rapidly and require
immediate attention. Standing orders are also common in the community
health setting, in which the nurse encounters situations that do not permit
immediate contact with a physician.
Before implementing any therapy, including those includes in standing
orders, must use sound judgment in determining whether the interventions
are correct and appropriate. Second, before implementing any intervention it
is the responsibility of a nurse to obtain the theoretical knowledge and
develop the clinical competencies necessary to perform the intervention.
Standing orders are the instructions and orders of specific nature. On
the basis of these, in the non availability of doctor, the nurse and health
workers can provide treatment to patient at home, hospital or health
instructions and community. Generally this instruction/order is in written
form, still in some medical instruction and health enterprises standing orders
are followed as tradition. It is appropriate to follow standing instruction only
on temporary basis, or in case of emergency or when doctor is absent.
BACKGROUND
Historically, standing orders have been used in many practice settings.
These documents provide guidance and direction for licensed nurses when
carrying out orders in the absence of a Licensed Independent Practitioner
DEFINITION
Standing Orders are orders in which the nurse may act to carry out specific
orders for a patient who presents with symptoms or needs addressed in the
standing orders. They must be in written form and signed and dated by the
Licensed Independent Practitioner.
Examples of situations in which standing orders may be utilized can include,
Administration of immunizations (e.g. influenza, pneumococcal, and
other
vaccines)
Nursing treatment of common health problems
Health screening activities
Occupational health services
Public health clinical services
Telephone triage and advice services
Orders for lab tests.
School health
During labor.
OBJECTIVES
1. To maintain the continuity of the treatment of the patient.
2. To protect the life of the patient.
3. To create feeling of responsibility in the members of health team.
USES
1. Providing treatment during emergency
2. Enhance the quality and activity of health service.
3. Developing the feeling of confidence and responsibility in nurses and
other health workers.
4. Protecting the general public from troubles.
5. Enhancing the faith of general public in medical institution.
THE DRUGS WHICH CAN BE AMINISTERED DURING ANTEPARTUM,
INTRAPARTUM, POSTPARTUM PERIOD BY A MIDWIFE WITHOUT
DOCTORS PRISCRIPTION
All intravenous and Controlled Drugs must be checked by two midwives.
NB: Any prescriptions for diamorphine and temazepam must be
countersigned by the duty doctor within 24 hours.
ANTEPARTUM
ANALGESIA
ANTACID
LAXATIVE
PROPHYLAXIS FOR
Ranitidine tablet 150mg at 22.00 on night
MENDELSONS SYNDROME before theatre, repeated two hours before
IN ELECTIVE LSCS
theatre. Sodium Citrate 0.3mg 30ml orally once
only immediately prior to transfer to Theatre
I.V. THERAPY
CANNULA
When required every 4-8 hours
LOCAL ANAESTHETIC
FOLIC ACID
DEMULCENT COUGH
PREPARATION
ANTISPASMODIC
ACTIVE MANAGEMENT
OF LABOUR
I.V. THERAPY
LOCAL ANAESTHETIC
LAXATIVES
EPISIOTOMY
PAEDIATRICS
The following may be administered to babies after delivery without reference
to Paediatric staff:
Oxygen by facemask
Phytomenadione 1mg by i.m. injection
POSTPARTUM
EPISIOTOMY REPAIR
ANALGESIA
NSAID ANALGESIC
ANTIEMETIC
LAXATIVES
HAEMORRHOID
PREPARATIONS
I.V. THERAPY
Compound Sodium Lactate 1 litre i.v. every 812 hours as required to a maximum of 2 litres
Heparin 10u/ml 5ml instilled into i.v. cannula
every 4-8 hours when required
LOCAL ANAESTHETIC
ANTI D
VACCINES
IRON SUPPLEMENT
DEMULCENT COUGH
PREPARATION
ANTISPASMODIC
S NO
2.
3.
or Dextrose Saline.
If an IV infusion was being
started in cases of PPH, it
was recommended the IV
fluid should be augmented
with 20U of Oxytocin for
every 500 ml bottle of fluid.
This could be continued
throughout transportation.
4.
Administration
antibiotics
5.
6.
was
a
universal
of There
consensus that only the
Medical Officer should be
allowed to administer antihypertensive to a woman
with
hypertension
in
pregnancy.
Removal of retained For incomplete abortion. If
products of conception. bleeding continues, the ANM
and staff nurses can perform
only digital evacuation of
products of conception.
Administration
antihypertensives
7.
8.
9.
RESEARCH ABSTRACT
A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-ergometrine
and Ergometrine-Oxytocin in Reducing Blood Loss in Active Management of 3rd
Stage of Labor.
Abstract
OBJECTIVES:
The purpose of the study was to compare the efficacy of misoprostol 400 g per rectally,
injection oxytocin 10 IU intramuscular, injection methylergometrine 0.2 mg intravenously
and injection (0.5 mg ergometrine + 5 IU oxytocin) intramuscular on reducing blood loss
in third stage of labor, duration of third stage of labor, effect on haemoglobin of the
patient, need of additional oxytocics or blood transfusion and associated side effects
and complications.
STUDY DESIGN:
A prospective non-randomized uncontrolled study was carried out in the Department of
Obstetrics and Gynecology, SSG Hospital and Medical College, Baroda enrolling 200
women and dividing them into four groups. Active management of 3rd stage of labor
was done using one of the 4 uterotonics as per the group of the patient. The main
outcome measures were the amount of blood loss, the incidence of postpartum
hemorrhage and a drop in hemoglobin concentration from before delivery to 24 h after
delivery.
RESULTS:
Methylergometrine was found to be superior to rest of the drugs in the study with lowest
duration of third stage of labor (P = 0.000096), lowest amount of blood loss
(P = 0.000017) and lowest incidence of PPH (P = 0.03). There was no significant
difference in the pre-delivery and the post-delivery hemoglobin concentration amongst
the four groups with P = 0.061. The need of additional oxytocics and blood transfusion
was highest with misoprostol as compared to all other drugs used in the study with
P = 0.037 and 0.009, respectively. As regards side effects, misoprostol was associated
with shivering and pyrexia in significantly high number of patients as compared to the
other drugs used in the study while nausea, vomiting and headache were more
associated with methylergometrine and ergometrine-oxytocin. However all the side
effects were acceptable and preferable to the excessive blood loss.
CONCLUSION:
Methylergometrine has the best uterotonic drug profile amongst the drugs used, strongly
favouring its routine use as oxytocic for active management of third stage of labor.
Misoprostol was found to cause a higher blood loss compared to other drugs and hence
should be used only in low resource setting where other drugs are not available. The
role of misoprostol in third stage of labor needs larger studies to be proved.
ABSTRACT:-2
Comparison of the efficacy of nifedipine and hydralazine in hypertension.
Source
BIBILOGRAPHY
1. Kamini Rao, textbook of midwifery and obstetrics for nurses, Elsevier
publication, 1st edition .
2. Annamma Jacob, text book of midwifery, 1st edition, jaypee publication
2005.
3. Adele pillitteri, child health nursing care of the child and family, 1 st
edition Lippincott publication.
4. Potter & perry , fundamentals of nursing,5 th edition, Elsevier
publication.
5. www.drugs2004rn.com.
6. www.pubmed.com
7. www.scribda,com