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NURS 320 - Exam 2 > Anesthesia for Obstetrics and Pain Relief > Flashcards

Anesthesia for Obstetrics and Pain Relief Flashcards

1
Q

A ______ is a specific area of skin that is innervated by a spinal nerve root

A

Dermatome

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2
Q

What is the primary cause of labor pain?

A

Cervical dilation

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3
Q

Where is stage 1 labor pain felt? (3)

A
  • Cervix
  • Uterus
  • Perineum
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4
Q

Where is stage 2 labor pain felt? (2)

A
  • Symphysis pubis
  • Lower back
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5
Q

What factors affect pain response / intensity of labor? (5)

A
  • Cervical readiness
  • Pelvis shape
  • Fetal position
  • Fatigue
  • Hunger
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6
Q

What factors contribute to maternal discomfort / exhaustion? (3)

A
  • Inability to relax
  • Inability to reposition
  • Inability to push effectively
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7
Q

______ can have a more adverse effects on the fetus than a small amount of analgesic

A

Maternal pain / discomfort

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8
Q

What are some non-pharmacological techniques for pain relief? (2)

A
  • Cutaneous stimulation (massage / TENS unit)
  • Hydrotherapy (warm water)
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9
Q

What is the goal of systemic analgesia?

A

Alleviate pain (not eliminate)

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10
Q

When is systemic analgesia most effective?

A

Early in labor - less effective as labor progresses

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11
Q

What are the possible routes of systemic analgesia? (2)

A
  • IV
  • IM
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12
Q

What classes of systemic drugs are used for analgesia? (2)

A
  • Opioids
  • Sedatives
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13
Q

Which narcotic antagonist can be used for reversal if needed?

A

narcan

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14
Q

What types of opioids are used for analgesia? (5)

A
  • demerol
  • morphine
  • fentanyl
  • stadol
  • nubain
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15
Q

When must opioids be given for analgesia?

A

Before 3 cm

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16
Q

Why are opioids not preferred during labor?

A

Risk of respiratory depression

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17
Q

What types of sedatives are used for analgesia? (3)

A
  • phenergen
  • benadryl
  • vistaril
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18
Q

What are the effects of pharmacologic measures on the fetus? (2)

A
  • Decreased FHR variability
  • Fetus cannot metabolize medications due to immature liver
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19
Q

It is important to hold ______ in fetal distress situations

A

Systemic analgesia

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20
Q

What is the most frequently used narcotic for labor pain?

A

butorphanol (Stadol)

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21
Q

What are the benefits of butorphanol (Stadol)? (2)

A
  • 30 - 40 times more potent than demerol
  • Safer for fetus
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22
Q

What is the primary side effect of nalbuphine (Nubain)?

A

Dizziness / drowsiness

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23
Q

Describe the primary nursing intervention associated with nalbuphine (Nubain)

A

Provide bedpan - patient should NOT get out of bed

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24
Q

What is the primary benefit of meperidine (Demerol)?

A

Crosses placenta within 90 seconds (pain relief within 6 minutes)

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25
Q

What should take place during effective pain relief? (3)

A
  • Mother should relax between contractions
  • Mother should maintain normal breathing
  • FHR should remain within normal limits
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26
Q

What are the contraindications of systemic analgesia? (2)

A
  • Before active labor starts in primigravida - if < 4 cm dilated, analgesia may prolong labor
  • 2 - 4 hours prior to birth - risk of neonatal respiratory depression
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27
Q

When is local infiltration given?

A

Before epiostomy / suturing

28
Q

What is the primary side effect of local infiltration?

A

Burning sensation

29
Q

Describe local infiltration (2)

A
  • Large amount needed to numb an entire area
  • No additional assessment of needed
30
Q

Describe regional anesthesia / analgesia (3)

A
  • Achieves pain relief without loss of consciousness
  • Blocks specific nerve pathways
  • Minimal fetal effects
31
Q

When is a paracervical block used?

A

First stage of labor

32
Q

A ______ is the next choice if an epidural block cannot be used

A

Paracervical block

33
Q

What type of pain is relieved by a paracervical block?

A

Cervical dilation pain

34
Q

Describe nursing considerations associated with a paracervical block (4)

A
  • 20cc of 1% lidocaine (10 cc on each side of cervix)
  • Pain relief within 5 minutes
  • Lasts 60 - 90 minutes
  • Can be repeated
35
Q

When is a pudenal block used?

A

Second stage of labor

36
Q

What type of pain is relieved by a pudenal block?

A

Vagina / perineum pain from pushing - does not block contraction pain

37
Q

What are the complications associated with a pudenal block? (4)

A
  • Toxic reaction
  • Rectal puncture
  • Hematoma
  • Sciatic nerve block
38
Q

When can an epidural block be given?

A

After active labor has been established ( > 4 cm)

39
Q

An epidural block infusion can be …

A

Continuous or intermittent

40
Q

Where is placement for an epidural block?

41
Q

What is the most common local epidural agent?

A

Bupivicaine

42
Q

Describe the composition of an epidural block

A

Local anesthetic (Bupivicaine) combined with opioid (morhpine, fentanyl, etc.)

43
Q

What are the contraindications of an epidural block? (4)

A
  • Thrombocytopenia ( < 100,000 platelets)
  • Uncorrected hypovolemia
  • Infection
  • Allergy
44
Q

Where is an epidural block injected in relation to the spinal cord?

A

OUTSIDE of the dura - should NOT see CSF fluid during injection

45
Q

What are the adverse effects of an epidural block? (5)

A
  • Inadvertent spinal
  • Bladder distention
  • Prolonged second stage
  • Catheter migration
  • Maternal hypotension
46
Q

What is an inadvertent spinal?

A

Accidental injection of anesthetic into dura mater - causes leakage of CSF

47
Q

What is the primary sign of an inadvertent spinal?

48
Q

How is a headache prevented after an inadvertent spinal?

A

Lay flat for several hours (not fully supine)

49
Q

Why can bladder distention occur due to an epidural block?

A

Patient is unable to sense full bladder - void Q 2 hours using catheter

50
Q

Why can the second stage of labor become prolonged due to an epidural block?

A

Patient is unable to sense need to push - discontinue epidural

51
Q

What is the primary nursing intervention used to prevent maternal hypotension during labor?

A

IV fluid pre-load (500 - 1000 cc bolus BEFORE epidural)

52
Q

What is the most common drug used to prevent maternal hypotension during labor?

53
Q

Describe the function of ephedrine

A

Vasoconstriction (except uterine arteries)

54
Q

What is the route of ephedrine?

55
Q

What is the most important vital sign to monitor after administration of an epidural block?

A

BP - monitor for maternal hypotension

56
Q

What are the side effects of duramorph? (4)

A
  • Pruritus - most common (dose related)
  • Urinary retention
  • Respiratory depression
  • Reactivation of herpes simplex I
57
Q

When does pruritus occur from duramorph?

A

3 hours after administration

58
Q

What drugs are used for the treatment of pruritus from duramorph? (2)

A
  • benadryl
  • narcan
59
Q

Which type of anesthesia is most common for c-section delivery?

A

Spinal anesthesia

60
Q

Why is spinal anesthesia preferred over an epidural block for c-section delivery? (2)

A
  • Faster onset - provides immediate anesthesia
  • Smaller dosage needed
61
Q

Where is placement for spinal anesthesia?

62
Q

Where is spinal anesthesia injected in relation to the spinal cord?

A

INTO the dura - SHOULD see CSF fluid during injection

63
Q

Which type of anesthesia is used for an emergency c-section / fetal distress?

A

General anesthesia

64
Q

General anesthesia causes …

A

Systemic loss of consciousness

65
Q

What are the adverse effects of general anesthesia? (2)

A
  • Aspiration of gastric contents
  • Uterine relaxation

NURS 320 - Exam 2 (6 decks)

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