CH 12 Pain Mgmt Flashcards
What is sacral counter pressure
Consistent pressure provided by the support person using the heel of the hand or fist against the clients sacral area to counteract pain in the lower back
Sedatives (barbiturates), such as secobarbital ( Seconal), pentobarbital ( Nembutal) and phenobarbital ( Luminal) should be used at what time during the labor process
They are not typically used during birth, but they can be used during the early or latent phase to relieve anxiety and induce sleep
What are adverse effects of sedatives
Neonate respiratory depression secondary to the medicine crossing the placenta and affecting the fetus.
Unsteady gait
Inhibitions of mothers ability to cope with the pain of labor
What are opioids such as meperidine hydrochloride ( Demerol), fentanyl ( Sublimaze), butorphanol ( Stadol) and nalbuphine ( Nubain) action?
They act in the CNS to decrease the perception of pain without the loss of consciousness.
It may be given IM or IV, the IV route is recommended because it has a faster effect
What are adverse effects of opioid analgesics
Crosses the placental barrier, if given to mother too close to the time of delivery
Can cause respiratory distress in the neonate
Reduces gastric emptying time; increases risk for N/V
Increases risk of aspiration of food and fluids in the stomach
Sedation, hypotension, tachycardia, allergic reaction
Decreased FHR variability
What 2 opioid analgesics can be administered that will provide pain relief without causing significant respiratory depression in the mother or fetus.
Butorphanol ( Stadol) and nalbuphine ( Nubain) can be given IM or IV
Prior to administering analgesics, what should the nurse verify
Verify that labor is well under established by performing a vaginal exam that reveals cervical dilation of at least 4 cm with a fetus that is engaged
Administer antiemetic a as prescribed
Monitor vital signs, uterine contractions pattern, continuous FHR monitoring
What 2 meds are used as an adjunct with opioids to control Nausea and anxiety.
Ondansetron ( Zofran) and metocloclopramide ( Reglan). They do not relieve pain
What is a epidural and spinal regional anesthesia
It consists of using analgesics such as fentanyl ( Sublimaze) and sufentanil ( Sufenta) which are short acting opioids that are administered as a motor block into the epidural or intrathecal space without anesthesia.
They produce regional anesthesia providing rapid pain relief while still allowing the client to sense contractions and maintain the ability to bear down.
What are adverse effects of epidural and spinal analgesia
Decreased gastric emptying results in N/V
Inhibition of bowel and bladder elimination sensations
Bradycardia or tachycardia
Hypotension, respiratory depression, allergic reaction and pruritis, elevated temp
The spinal block eliminates sensation where
From the level of the nipples to the feet. Commonly used for C Sections
When are spinal blocks administered
Late in the second stage or before a C Section
What are adverse effects of a spinal block
MAternal hypotension
Fetal bradycardia
Loss of bearing down reflex
Potential headache from leakage of cerebrospinal fluid at the puncture site
Higher incidence of maternal bladder and uterine agony following birth
What are nursing assessment for a spinal block
Maternal vital signs Q 10 min
Manage maternal hypotension by administering IV fluid bonus as prescribed
Assess uterine contractions/FHR patterns, level of anesthesia
Recognize signs of impending labor
What is effleurage
Light gentle circular stroking of the clients abdomen with the fingertips in rhythm with breathing during contractions
