Evaluation in Nursing Education Rhogam Medication Portfolio

1. Generic Name RhoGAM Therapeutic Classification Vaccines/immunizing agents 2. Indications and mechanism of action Trade Name MicRhoGAM Pharmacological Classification Immune globulins Indications: is an immune globulin indicated for use in preventing Rh immunization for pregnancy and other obstetrical conditions in Rh-negative women unless the father or baby is conclusively Rh-negative, e.g., delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby, any antepartum fetal-maternal hemorrhage (suspected or proven), actual or threatened pregnancy loss at any stage of gestation and ectopic pregnancy. Mechanism of action: RhoGAM immune globulin act by suppressing the immune response of Rh-negative individuals to Rh-positive red blood cells. a. Safe dosage range (and route) Intravenous or Intramuscular dosage: Adult and adolescent females 300 mcg (1500 international units) IM or IV at 28 weeks gestation. If administered earlier in pregnancy, give at 12-week intervals during pregnancy to maintain sufficient levels of passively acquired anti-Rh0 [D] antibodies. A 120 mcg (600 international units) IM or IV dose should be given as soon as possible and preferably within 72 hours of delivery of a confirmed Rh0 [D]-positive infant. If Rh status of the infant is unknown at 72 hours or > 72 hours have passed, do not withhold the dose. Administer as soon as possible, up to 28 days after delivery. 3. Adverse Effects (life threatening) and Common Side Effects fever, chills, shaking, back pain, unusual weakness, red or pink urine; pale or yellowed skin, dark colored urine; rapid breathing, rapid heart rate, confusion, feeling short of breath; look for signs of kidney failure--little or no urinating, swelling, rapid weight gain; or signs of a blood clot--sudden numbness or weakness, slurred speech, problems with vision or balance, chest pain, coughing up blood, swelling with redness and warmth in one or both legs. Individuals known to have had an anaphylactic or severe systemic reaction to human globulin should not receive RhoGAM (rho(d) immune globulin (human)) , MICRhoGAM (rho(d) immune globulin (human)) or any other Rho(D) Immune Globulin (Human). 1. Nursing administration guidelines: a. Nursing process – assessment (ex: lab values, VS) -Obtain history of systemic allergic reactions to human immune globulin preparations prior to drug administration. -Send sample of newborn's cord blood to laboratory for cross-match and typing immediately after delivery and before administration of Rho(D) immune globulin. Confirm that mother is Rho(D) and Du-negative. Infant must be Rh-positive. b. Nursing process – intervention (when to give, hold or not give, lab values, VS) -Must be given within 72 hours after delivery to prevent antibody formation by immune system. c. Nursing process – evaluation (after administration of medication) Prevention of erythroblastosis fetalis in future RhO (D) positive infants. 2. Nursing implications and considerations - include Lab value alterations caused by medication, and drug incompatibility or interactions with foods and other drugs. Type and antibody screening of the mother's blood and cord blood type of the newborn must be performed to determine the need for the medication. The mother must be Rh-negative and negative for Rh antibodies. The newborn must be Rh-positive. If the fetal blood type after termination of pregnancy is uncertain, the medication should be administered. The newborn may have a weakly positive antibody test if the woman received Rho(D) immune globulin during pregnancy. The drug is administered to the mother, not the infant. The deltoid muscle is recommended for IM administration. 3. Patient / family teaching Be aware that administration of Rho(D) immune globulin (antibody) prevents hemolytic disease of the newborn in a subsequent pregnancy.