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On Standing Order

This document outlines standing orders and protocols for using selected lifesaving drugs and interventions for obstetric emergencies approved by MOHFW. It defines standing orders, lists objectives like maintaining treatment continuity and protecting life. It provides examples of drugs administered during antepartum, intrapartum, and postpartum, including analgesics, IV therapy, local anesthetics. Lifesaving drugs mentioned are misoprostol, oxytocin, magnesium sulfate. The conclusion states that nurses must have knowledge on factors impacting women's health to help increase control and improve health status.

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Piyush Dutta
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2K views

On Standing Order

This document outlines standing orders and protocols for using selected lifesaving drugs and interventions for obstetric emergencies approved by MOHFW. It defines standing orders, lists objectives like maintaining treatment continuity and protecting life. It provides examples of drugs administered during antepartum, intrapartum, and postpartum, including analgesics, IV therapy, local anesthetics. Lifesaving drugs mentioned are misoprostol, oxytocin, magnesium sulfate. The conclusion states that nurses must have knowledge on factors impacting women's health to help increase control and improve health status.

Uploaded by

Piyush Dutta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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STANDING ORDERS AND PROTOCOLS AND

USE OF SELECTED LIFE SAVING DRUGS


AND INTERVENTIONS OF OBSTETRIC
EMERGENCY APPROVED BY MOHFW

Mrs. Ankita Manna


M.Sc Nursing,1st yr
EBMCON
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.
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.
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

To maintain the


continuity of the
treatment of the
patient.
To protect the life
of the patient.
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.
DRUGS ADMINISTERED DURING
ANTE PARTUM
All IV and Controlled Drugs must be checked by two
midwives.
ANALGESIA- Paracetamol 1 gram as a single dose,
once only
ANTACID- Maalox suspension 10ml as a single
dose, once only
 or Peptac liquid 10-20ml as a single dose, once
only
LAXATIVE- Ispaghula Husk 3.5g one sachet in
water, once only
Cont……
IN ELECTIVE LSCS Sodium Citrate 0.3mg 30ml orally
once only immediately prior to transfer to Theatre

I.V. THERAPY Compound Sodium Lactate 1 litre i.v.


over 8-12 hours, to a maximum of two litres

Heparin 10 IU/ml 5ml


instilled into i.v. cannula
When required every
4-8 hours
Cont….
 LOCAL ANAESTHETIC- Lignocaine 1% 0.1ml intradermal prior to cannulation
once only or Amethocaine gel 4% 1g 45 minutes prior to venous cannulation
once only

 NIGHT SEDATION -Temazepam 10mg as a single dose up to 2.00am in the


morning.

 DINOPROSTONE VAGINAL GEL -as per induction of labour guidelines.



 FOLIC ACID -Folic acid 400microgram tablet once daily, until 12-14 weeks’
gestation.

 DEMULCENT COUGH -Simple linctus 5ml once only PREPARATION

 ANTISPASMODIC- Peppermint water 10ml in plenty of water, once only.


Cont…
ANTI –D IMMUNOGLOBULIN- Anti-D
immunoglobulin may be given to all non-sensitized
Rh D negative women within 72 hours of a sensitizing
event in the following circumstances.

Routine Ante-natal Anti-D prophylaxis


Anti-D 500i.u. by i.m. injection at 28 and 34 weeks
gestation
DRUGS ADMINISTERED
DURING ITRAPARTUM
ANALGESIA -Entonox inhalation as required

ANTI-EMETICS Cyclizine- 50mg i.m. every 8 hours


as required to a maximum of 150mg/24 hours
OR
Metoclopramide 10mg i.m. every 8 hours as required
to a maximum of 30mg in 24 hours or 500 micrograms
per Kg in 24 hours for women<60 kg.
Cont…
ACTIVE MANAGEMENT OF LABOUR-Oxytocin 10
i.u.as per unit policy.
OR
Syntometrine 1ml i.m. with anterior shoulder at
delivery
I.V. THERAPY Compound Sodium Lactate 1 litre
i.v. over 8-12 hours as required to a maximum of 2
litres
Heparin-10u/ml 5ml instilled into i.v. cannula every
4-8 hours when required
Cont…
LOCAL ANAESTHETIC Lignocaine 1% 0.1ml intradermal prior to
cannulation, once only
Amethocaine gel 4% 1g prior to cannulation once only

LAXATIVES-Glycerine Suppository 1
or 2 per rectum
or
Docusate sodium 90mg micro enema
as required
 
EPISIOTOMY -Lignocaine 1% 10ml by perineal
infiltration.
Cont…
PAEDIATRICS
The following may be administered to babies after
delivery without reference to Paediatric staff:

Oxygen by facemask

Phytomenadione 1mg by
i.m. injection
DRUGS ADMINISTERED DURING
POSTPARTUM

EPISIOTOMY REPAIR Lignocaine 1%


by Perineal infiltration to a maximum
0f 20 ml.

ANALGESIA-Only one NSAID should


be prescribed at any one time
Cont…
Caesarean Section for first 24 hours:
Anaesthetist will be responsible for
analgesia. Unless contra-indicated
diclofenac suppository 100mg will be given
rectally in Theatre. One dose of an NSAID
can be given 14-16 hours after the
suppository. If Diclofenac is given, the total
dose must not exceed 150mg by all routes in
any 24 hours’ period.
Cont…
Vaginal delivery or Caesarean Section after first 24
hours:
Ibuprofen tablet or syrup 400mg or 600mg three
times a day.
Diclofenac tablet or suppository 50mg three times a
day (to a maximum of 150mg in 24 hours by any
route).
Cont…
PARACETAMOL Only one paracetamol based
analgesic should be prescribed at any one time.

ANTIEMETIC Cyclizine 50mg i.m. every 8 hours as


required to a maximum of 150mg/24 hours.
or
Metoclopramide 10mg i.m. every 8 hours as required
to a maximum of 30mg in 24 hours or 500 micrograms
per Kg in 24 hours for women<60kg
Cont…
LAXATIVES Ispaghula Husk 3.5g, 1 sachet in water
twice daily
Lacunose 10ml orally twice daily
Glycerine suppository 1 or 2 per rectum as
required
HAEMORRHOID- Anusol cream apply twice daily
and after each bowel movement
Scheriproct ointment apply twice daily
for 5-7 days then once daily until symptoms cleared
Cont…
I.V. THERAPY- Compound Sodium Lactate 1 litre i.v.
every 8-12 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- Lignocaine 1% 0.1ml


intradermal prior to cannulation, once only
Amethocaine gel 4% 1g prior to venous
cannulation once only
Cont…
ANTI –D Anti-D Immunoglobulin 500i.u or more
By i.m. injection or Rh D negative women with a Rh D
positive baby within 72 hours of delivery as per
obstetric unit guidelines.
VACCINES Rubella vaccine (live)
0.5ml by deep subcutaneous
or intramuscular injection
If mother not immune.
Cont…
IRON SUPPLEMENT Ferrous
sulphate tablet 200mg three
times a day if haemoglobin
below 10g/dl.

DEMULCENT COUGH Simple linctus 5ml 3-4 times a


day.

ANTISPASMODIC Peppermint water 10ml in plenty


of water, once only.
LIFE SAVING DRUGS
Tab misoprostol

IV Infusion and injection


 of oxytocin

Injection magnesium sulphate

 Use of Gentamycin IM, Ampicillin and metronidazole orally


for prevention of infection (pureperial sepsis, premature
rupture of membranes, prolong labour,any manual
intervention )
Summary

So far I discussed about standing orders, use of


selected lifesaving drugs and interventions of
obstetrics emergencies, introduction, definition,
examples of standing order, objectives of standing
order, uses of standing order, drugs administered
during antepartum, intrapartum and postpartum,
lifesaving drugs and its recommendation.
CONCLUSION

Nurses must have a solid knowledge based on the


factors affecting maternal, new-born and women’s
health and barriers to health care. It is useful for
identifying high-risk groups. Nurse can help women to
increase control over the factors that affecting health,
thereby improving their health status

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