Hey everyone, it's nurse Sarah and in this video I want to do a farm review over ptocin. And after you get done watching this video, don't forget you can access a free quiz that will test you on this material. So let's get started. Ptocin, also known as oxytocin, is a hormone that stimulates uterine contractions. It also plays a role with allowing the breast to release milk. So that let down reflex. Ptocin is also naturally released by the posterior pituitary gland in the form of oxytocin. And we can give it synthetically in the form of ptocin. So why would we give ptocin to a patient? Well, you would give it to a patient to help start or hence help labor progress. So we're augmenting their labor or it can be used to treat postpartum hemorrhage after birth. How is ptocin administered? Well, we can give it IM, so in the muscle. This is generally after birth to help control bleeding. Or we can give it IV via an infusion pump where we're going to give it IV piggyback. So here you have your bag of ptocin hanging. It is piggybacked into a primary bag of fluids. So you always want to follow your hospital's protocol on how they want you to administer this. So if you're going to be working in a maternity area, look at that protocol. Get really familiar with it. But for example, how we give it, it started very low and slow. For example, it's given in millunits. So one millunit per minute. That's where we start them. And then we increase it by 1 to 2 millunits per minute every 30 to 60 minutes per that health care provider's parameters. So you're going to look at the parameters the healthcare provider wants you to have. Plus you want to take a look at your patients. How's mom and baby responding to this? Now this medication is given in various concentrations. That's going to depend on what your facility has. So you just want to be familiar with that. It's mixed in an isotonic solution like lactated ringers or normal saline. So you could have a bag that says there's 30 units per 500 mls, 10 units per 1,000 mls, or 20 units per 2,000 mls. Now let's talk about how ptocin works. How does this medication help that uterus to contract? Because if we can understand this on a cellular level, it's going to be easy to recall those side effects that we need to monitor for our nurse's role and etc. So, what I'm going to do is I'm going to walk you through this and I've tried to simplify this because quite frankly, this process can get really crazy. And in nursing, we really just need to know the gist of why this medication is doing what it's doing. So, one of the big things that you want to remember that ptocin does to achieve those uterine contractions is that it's trying to increase the calcium inside the cell. So the intracellular calcium because if it can do this it will activate the myofilaments hence those contractile proteins on the uterus so we can get uterine contractions that's it's really a big goal so how can you remember that let's say you're taking a form exam and it says how does ptocin work to cause uterine contractions well how I remember is look at the word ptocin oxytocin I see that C and the I in the end and that helps me remember for the C it's calcium and it's going to increase it I and increase it inside the cell. Hopefully that will help you recall that. Just a little memory aid. Okay, now back to how it works. Okay, so first let's talk about our key players. Of course, one key player is the oxytocin. That is our hormone that causes uterine contractions among other things. Next key player is our oxytocin receptor. This is a special receptor that hangs out on that smooth muscle of the myometrium and it will bind with this oxytocin. And then our other key player is a special ion known as you probably already guessed it calcium. So the calcium plays a huge role with muscle contractions especially in the uterus and we want to increase that amount so we can activate those myofilaments. Okay. So first off let me go over this drawing with you just a little bit. We have the cell. Okay. this part in here labeled it's inside the cell. So this is our intracellular area. This is where all the action is really happening. And then we have the outside of the cell. So that's extracellular area. Okay. So first we're going to start on the outside of the cell. We've given the patient ptocin. So our molecule synthetic molecule of oxy pitocin is here hanging out. It's going to go and it's going to bind with this oxytocin receptor. it's ready to accept it because they are alike. And whenever it accepts it and binds with it, it's going to set off this like chain of events inside of the cell. So we have the binding here and this is going to activate this enzyme known as phospholipase C. When we have this enzyme activated, it's going to create another substance known as anositol tris phosphate. And this is also known as IP3. So that's what we'll call it because that's so much easier to say. So whenever we have this IP3 here, it influences an important part in your cell that's very sensitive to it. It's known as the sarcoplasmic reticulum. This little cool structure stores our calcium. So whenever we have IP3 here, it influences it and causes it to release extra stoages of calcium. So now we have this calcium inside of our cell that's now increased the amounts of calcium that's naturally there. So whenever we have that that is actually going to cause the myofilaments those are those contractile proteins like actin and meosin to go from this relaxed state to in a sense they're going to clamp down and contract which is what we're trying to do. We're trying to augment labor many times whenever we're giving ptocin. So we want that to happen. Now because this is happening, we're actually going to get some more calcium inside the cell because of this process. So outside the cell on this cell membrane, you have these calcium voltage gate channels and this is going to allow the calcium that's hanging out extracellularly extracellularly to flow inside of the cell. So this is further going to increase our calcium levels which will help increase the frequency and the strength of contractions. Some other things you want to remember about how btocin works is that whenever we give it IV, it works within a few minutes. However, it has a short halflife about one to six minutes. So, whenever we stop the infusion, those levels of ptocin can decrease rapidly because of that short halflife. Now, if you're studying anything about ptocin, you may come across that ptocin can lead to water intoxication, hyponetriia, and hypertension. So, why is that? Why do we have to watch out for that? Well, ptocin can actually have antidiuretic and presser effects in the body, especially if the patient is receiving high doses of this. They've been on it for a while on that drip for a long time or they have also been given high amounts of hypotonic fluids. So interestingly, ptocin actually shares some similarities with vasopressin which is also known as ADH antidiuretic hormone because they are both produced by the hypothalammus. They're released by the posterior pituitary gland and they have similar molecular structures. So just to recap what antidiuretic hormone does, we talked about in detail when we talked about our fluid and electrolyte videos. So if you want to check that out, get a more review on that, you can access those up there. What it does, remember whenever we give patients diuretics, what do they do? They cause the patient to urinate, hence rid themselves of fluid. Well, if we have anti-iuretic hormone, we're going to do the opposite effect of that. We are going to retain fluid. So whenever the body is retaining fluid, it can cause problems. It could give the patient way too much fluid in their intervascular system, which can lead to water intoxication. We also have electrolytes in there. So if we water it down, we can water those out. Hence cause hyponetriia, lowering that level. Plus with this pressure effect, we can cause some constriction and we have the higher amounts of fluid in our vascular system that can increase our blood pressure. So as the nurse, you definitely want to monitor for that because that can occur. Now what are some situations where ptocin should not be used? If the patient has cervical cancer, placenta privia, this is where we have a lowline placenta over or near the cervix. The fetus is large, greater than 9.9 lbs or 4500 g, gestational age less than 39 weeks, there's a cord prolapse, active genital herpes infection or abnormal fetal position such as transverse lie or another malpresentation. Now, let's talk about the side effects of ptocin, what you got to be monitoring for. And how I'm going to do this is we're going to talk about the side effects that you expect to happen versus adverse effects that are happening. That tells you your patient's receiving way too much ptocin. So first up are side effects that we expect that's going to happen. Patient of course is going to have uterine contractions. They may also experience nausea and vomiting. The goal again of ptocin is to simulate those uterine contractions where we have a normal pattern frequency and intensity. So, we're getting this cervix to dilate and we want to achieve this with the lowest effective dose possible. So, we want to avoid hyper stimulation of the uterus where we're making it contract way too much because whenever we do that, we're going to impede blood flow to the baby and we don't want to cause fetal distress. So, always look at your hospital's parameters and how your patient should be presenting while they're on ptocin. So for example, we would maybe want one contraction every 2 to 3 minutes lasting about 40 to 70 seconds with moderate to strong palpation. And having this will help mother and baby to recover between each contraction and it's going to ensure that we have adequate blood flow to that placenta. So if we have good blood flow to that placenta that means the baby is getting the nourishment that they need. So as labor progresses the ptocin will be turned off typically when they're in that active phase where our cervix is getting to about five cmters. And by doing this we can allow the natural production of oxytocin to be secreted. So by doing that that's going to help hopefully decrease fetal distress, the over stimulation of the uterus and so forth. Now what are those adverse effects that you got to watch out for? This tells you that if these signs and symptoms are presenting that your patient's getting way too much ptocin. Well, to help us remember that, remember this pneumonic I created called pit drip. First is painful or intense contractions with little to no uterine relaxation. Also, increase uterine tone. This is where our uterus is remaining firm between contractions. And how we can know about this is like through an intrauterine pressure catheter which can be inserted in the uterine cavity to provide pressure readings. A resting normal uterus reading would be less than about 10 to 15 millimeters of mercury and it would not be a good sign if it was greater than 20 millm of mercury. This tells us that our uterus is way over stimulated and again this can lead to fetal distress and placenta problems. Next is tachi. This is where we have more than five contractions in 10 minutes averaged over 30 minutes in addition to a duration of contractions where they're greater than 120 seconds which is 2 minutes. That tells us that we have prolonged contractions. The resting time is less than 60 seconds between contractions. So contractions are occurring too frequently. Irregular fetal heart rate patterns where you're seeing variable or late decelerations. This is not a good sign. And then lastly, ptocin induced fluid retention. This is talking about water intoxication or the hyponetriia due to that vasop prein-like effect that we talked about earlier. And this can present as a patient having a headache, confusion, shortness of breath, seizures, and swelling. Now, let's talk about your role as a nurse whenever you have a patient on ptocin. So, a huge thing you're going to be doing is you are going to be monitoring your patients. So, you're going to be doing continuous monitoring per protocol. That protocol will dictate to you how often you're measuring the vital signs and watching that fetal heart rate. So with mom's vital signs, you're looking at them all across the board. Particularly, one thing I want to point out about the blood pressure is that your patient could experience hypotension or hypertension. So a low or high blood pressure, it can go either way. So the reason for the hypotension is because in low doses ptocin can actually cause vasoddilation. in high doses because of that pressor like effect or if they're having intense contractions you could see hypertension. So just keep that in mind. You also want to be monitoring mom's contractions looking at that frequency, the strength, the duration. Are they being helpful? Is that cervix actually dilating? And you're going to be monitoring that fetal heart rate. Plus you want to do strict eyes and O's because again there's that risk for water intoxication. So we want to know what's going in and what's going out. Plus, that tells us about renal function and looking at the lab work, making sure our sodium level is staying within normal range, plus those other electrolytes. Now, on exams, you're probably going to get questions of worst case scenario. You have a patient who's having way too much uterine stimulation, like they're having frequent contractions, there's no rest between them, they're intense, their duration is long, and then your patient, your other patient has nonreassuring fetal heart rate tones that you're seeing. What are you going to do? Well, to help you remember what you're going to do, remember another pneumonic I created called the five S's. You want to stop that ptocin infusion to prevent further uterine stimulation. Shift the patient to the lateral side. Left side is the best, but right can be used too. This is going to help optimize the uterine blood flow. Then supply the patient with an IV bolus per protocol. This could be, let's say, like 500 mls of lactated ringers. And this is going to help improve circulation and fetal oxygenation. However, you want to be mindful of the patient's fluid status already. Then see how the patient and the baby have responded. If the fetal heart rate is still abnormal, you may want to consider supplying with oxygen. This could be anywhere between 8 to 15 L per minute via a nonrebreather mask. And if the fetal heart rate is still non-reassuring after this, you may want to consider subcutaneous turbutilene and this is used as a toolytic to reverse that uterine hyper stimulation. It's a betaist that relaxes the uterus. However, with this you want to watch for tacocardia and mom and hypoglycemia. Okay, so that wraps up this review on ptocin. And don't forget to access the free quiz that will test you on this material that we just covered, which you can access in the link in the description below.