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Women's Health > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

examples of sedatives

A

Barbiturates
Benzodiazepines
Phenergan

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2
Q

why are sedatives not usually appropriate for labor

A
  • they can affect the baby

- may only be appropriate if woman is anxious to promote sleep or rest

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3
Q

this type of pain relief is incomplete, temporary, and more effective in the early part of active labor

A

opioids (systemic analgesic)

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4
Q

we give IV pain meds when….

A

there are contraindications to epidurals

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5
Q

contraindications to epidural (epidurals not given if…)

A

MRSA lesions on their back, spinal surgery, idiopathic thrombocytopenia

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6
Q

why contraindicated in MRSA lesions on back

A

anesthesia wont go through to give the epidural

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7
Q

why contraindicated in spinal surgery

A

extensive surgery, rods, screws, and plates can mess up epidurals

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8
Q

why contraindicated in idiopathic thrombocytopenia

A
  • get more plasma volume during pregnancy which decreases the amount of circulating platelets and sometimes the pt platelet count may drop below 100, 000
  • epidural could hit a vein and cause bleeding
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9
Q

if pt platelet count is below ____ they will not get epidural but may get IV pain meds

A

100,000

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10
Q

what is the opiod (narcotic) agonist analgesic typically used in labor

A

Fentanyl

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11
Q

what is important to remember about Fentanyl

A

never give 1 hr prior to delivery due to neonatal respiratory depression

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12
Q

if there is neonatal respiratory depression…

A

baby will not clear airway and won’t breathe

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13
Q

why is Fentanyl used so often now

A

it will NOT make mom fuzzy but remember it DOES go to the baby somewhat

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14
Q

what is the opiod agonist antagonist analgesic

A

Stadol and Nubain

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15
Q

Stadol causes

A

mom to be light headed and hallucinate (truth serum because it uninhibited people begin telling the truth)

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16
Q

Nubain causes

A

Produces more of a morphine like response

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17
Q

important to remember with Stadol and Nubain

A

never give 1 hr prior to delivery due to neonatal respiratory despression

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18
Q

what is priority with pain meds

A

Patient Safety-do not want pt getting out of bed with any of these narcotics without supervision, keep bed in lowest position, call bell within reach and side rails up x2

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19
Q

what do opioids do to vitals

A

decrease maternal heart, respiratory rate, and blood pressure AND fetal oxygenation

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20
Q

what should be documented and on hand before mother is given opioids

A

maternal vitals and FHR should be documented and Narcan should be on ohand

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21
Q

if Narcan is given to a drug user…

A

watch for withdrawal response and potential maternal opioid abstinence syndrome

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22
Q

local anesthetic agent

A

bupivacaine and ropivacaine

23
Q

opioid analgesic

A

fentanyl and sufentanil

24
Q

_____ effectively relieves the pain caused by uterine contractions

A

epidural anesthesia

25
Q

prior to procedure (epidural) nursing interventions are

A 
hx of spinal surgery
skin lesions
CBC> 100,00
consent for anesthesia
preload pt with NS/LR
26
Q

why do platelets need to be greater than 100,000

A

so they don’t have risk for bleeding

27
Q

how much fluid do you preload pt with before epidural

A

500 mL to 2 L of NS/LR

28
Q

why do you preload pt before epidural

A

to prevent hypotension in mom and bradycardia in baby

29
Q

during procedure (epidural) nursing interventions are

A

monitor heart rate to ensure pt is safe during test dose

30
Q

how do you know if epidural placement is wrong

A

if heart rate spikes up

31
Q

post procedure (epidural) nursing interventions are

A
  • monitor vitals (watch for hypotension and decreased O2 to baby)
  • bladder care
  • safety
  • continuous fetal monitoring
32
Q

bladder care post epidural

A

pt should never go more than 4 hrs without being cathed after epidural

33
Q

safety post epidural

A

side rails up x2, bed in lowest position, call bell within reach

34
Q

used during childbirth in the lumbar/sacral area of spine

A

epidural anesthesia

35
Q

where is epidural needle inserted

A

between L4 and L5 and into the epidural space (negative space)

36
Q

what needle is used in epidural

A

Tuohy needle

-has the catheter inside (not outside)

37
Q

how do you know if the epidural has gone into the vein

A

mother has metallic taste in mouth or goes tachy or has no lower limb movement within 3-5 min of test dose

38
Q

types of nonpharmacologic pain management

A

hydrotherapy, application of heat and cold, hypnosis

39
Q

types of nonpharmacologic management of discomfort

A

biofeedback, aroma therapy, intradermal water block

40
Q

hydrotherapy key points

A

water on back (always fine)

laboring in warm water (fine if water is NOT broken)

41
Q

why can women not labor in water once waters break

A

open to bacteria which opens the risk for infections

potential for baby to inhale fluid instead of air which can cause lung infections

42
Q

heat does what to back

A

dilates

43
Q

what is pudendal nerve block

A

an injection of a local anesthetic at the pudendal nerve root

44
Q

what will pudendal nerve block not relieve

A

pain from uterine contractions

45
Q

when should pudendal nerve block be administered

A

10-20 min before perineal anesthesia

46
Q

why would a mother request a pudendal nerve block

A

due to the pain level she has experienced during the 2nd and 3rd stage of labor
it will provide more comfort and decrease her vaginal pain

47
Q

the return of the uterus to a nonpreganant state after birth

A

involution process

48
Q

when does involution begin

A

immediately after expulsion of the placenta with contraction of the uterine smooth muscle

49
Q

24 hours after birth uterus is what size

A

same size as it was at 20 wks gestation

50
Q

fundus descends at what rate

A

1 to 2 cm every 24 hrs

51
Q

the uterus should not be palpable…

A

abominably after 2 weeks

52
Q

when should the uterus return to its nonpregnant location

A

by 6 weeks after birth

53
Q

nursing intervention post partum

A
  • use to hand maneuver to check uterine tone
  • firm fundus (no bleeding)
  • empty bladder
  • monitor VS
  • monitor for blood loss

Women's Health (31 decks)

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