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Seminar On Standing Orders and Protocols and Use of Selected Life Saving
Seminar On Standing Orders and Protocols and Use of Selected Life Saving
SUBMITTED TO:-
Mrs. SOMIBALA THOKCHOM
TUTOR
R.C.O.N
SUBMITTED BY:-
VARSHA SHARMA
MSC NURSING FIRST YEAR
RUFAIDA COLLEGE OF NURSING
INDEX
SNO CONTENT PAGE NO TEACHERS
SIGNATURE
1 INTRODUCTION 2
2 STANDING ORDERS 2
DEFINITION 3
OBJECTIVES 3
USES 3
STANDING ORDER FOR A MIDWIFE
DURING:- 4
ANTEPARTUM 6
INTRAPARTUM 8
3 POSTPARTUM 11
4 LIST OF LIFE SAVING DRUGS AND ITS 15
5 RECOMMENDATION 15
6 CONCLUSION 18
RESEARCH ABSTRACTS
BIBILOGRAPHY
STANDING ORDERS, USE OF SELECTED LIFE SAVING DRUGS AND
INTERVENTIONS OF OBSTETRICS EMERGENCIES APPROVED BY THE
MOHFW
INTRODUCTION
A sound understanding of the principle of safe medication management
is essential for all nurses, midwifes and health agencies involved in the care of
patient, residents and clients.
STANDING ORDERS
A standing order is a document containing orders for the conduct of
routine therapies, monitoring guidelines, and/or diagnostic procedure for
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 client’s 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
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.
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.
ANTEPARTUM
ANALGESIA Paracetamol 1gram as a single dose, once
only
ANTI –D IMMUNOGLOBULIN
INTRAPARTUM
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
ANALGESIA
NSAID ANALGESIC Only one NSAID should be prescribed at any one time
CONCLUSION
RESEARCH ABSTRACT
OBJECTIVES:
The purpose of the study was to compare the efficacy of misoprostol
400 μg 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
Department of Obstetrics & Gynecology, Women Hospital, Tehran
University of Medical Sciences, Iran.
Abstract
Intravenous hydralazine is a commonly administered arteriolar
vasodilator that is effective for hypertensive emergencies associated
with pregnancy. Oral nifedipine is an alternative in management of these
patients. In this study the efficacy of nifedipine and hydralazine in
pregnancy was compared in a group of Iranian patients. Fifty
hypertensive pregnant women were enrolled in the study. A randomized
clinical trial was performed, in which patients in two groups received
intravenus hydralazine or oral nifedipine to achieve target blood pressure
reduction. The primary outcomes measured were the time and doses
required for desired blood pressure achievement. Secondary measures
included urinary output and maternal and neonatal side effects. The time
required for reduction in systolic and diastolic blood pressure was
shorter for oral nifedipine group (24.0 ± 10.0 min) than intravenus
Hydralazine group (34.8 ± 18.8 min) (P ≤ 0.016). Less frequent doses
were required with oral nifedipine (1.2 ± 0.5) compared to intravenus
hydralazine (2.1 ± 1.0) (P ≤ 0.0005). There were no episodes of
hypotension after hydralazine and one after nifedipine. Nifedipine and
hydralazine are safe and effective antihypertensive drugs, showing a
controlled and comparable blood pressure reduction in women with
hypertensive emergencies in pregnancy. Both drugs reduce episodes of
persistent severe hypertension. Considering pharmacokinetic properties
of nifedipine such as rapid onset and long duration of action, the good
oral bioavailability and less frequent side effects, it looks more preferable
in hypertension emergencies of pregnancy than hydralazine.
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, 1st
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