Exam 3 Flashcards
examples of sedatives
Barbiturates
Benzodiazepines
Phenergan
why are sedatives not usually appropriate for labor
- they can affect the baby
- may only be appropriate if woman is anxious to promote sleep or rest
this type of pain relief is incomplete, temporary, and more effective in the early part of active labor
opioids (systemic analgesic)
we give IV pain meds when….
there are contraindications to epidurals
contraindications to epidural (epidurals not given if…)
MRSA lesions on their back, spinal surgery, idiopathic thrombocytopenia
why contraindicated in MRSA lesions on back
anesthesia wont go through to give the epidural
why contraindicated in spinal surgery
extensive surgery, rods, screws, and plates can mess up epidurals
why contraindicated in idiopathic thrombocytopenia
- 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
if pt platelet count is below ____ they will not get epidural but may get IV pain meds
100,000
what is the opiod (narcotic) agonist analgesic typically used in labor
Fentanyl
what is important to remember about Fentanyl
never give 1 hr prior to delivery due to neonatal respiratory depression
if there is neonatal respiratory depression…
baby will not clear airway and won’t breathe
why is Fentanyl used so often now
it will NOT make mom fuzzy but remember it DOES go to the baby somewhat
what is the opiod agonist antagonist analgesic
Stadol and Nubain
Stadol causes
mom to be light headed and hallucinate (truth serum because it uninhibited people begin telling the truth)
Nubain causes
Produces more of a morphine like response
important to remember with Stadol and Nubain
never give 1 hr prior to delivery due to neonatal respiratory despression
what is priority with pain meds
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
what do opioids do to vitals
decrease maternal heart, respiratory rate, and blood pressure AND fetal oxygenation
what should be documented and on hand before mother is given opioids
maternal vitals and FHR should be documented and Narcan should be on ohand
if Narcan is given to a drug user…
watch for withdrawal response and potential maternal opioid abstinence syndrome
local anesthetic agent
bupivacaine and ropivacaine
opioid analgesic
fentanyl and sufentanil
_____ effectively relieves the pain caused by uterine contractions
epidural anesthesia
prior to procedure (epidural) nursing interventions are
hx of spinal surgery skin lesions CBC> 100,00 consent for anesthesia preload pt with NS/LR
why do platelets need to be greater than 100,000
so they don’t have risk for bleeding
how much fluid do you preload pt with before epidural
500 mL to 2 L of NS/LR
why do you preload pt before epidural
to prevent hypotension in mom and bradycardia in baby
during procedure (epidural) nursing interventions are
monitor heart rate to ensure pt is safe during test dose
how do you know if epidural placement is wrong
if heart rate spikes up
post procedure (epidural) nursing interventions are
- monitor vitals (watch for hypotension and decreased O2 to baby)
- bladder care
- safety
- continuous fetal monitoring
bladder care post epidural
pt should never go more than 4 hrs without being cathed after epidural
safety post epidural
side rails up x2, bed in lowest position, call bell within reach
used during childbirth in the lumbar/sacral area of spine
epidural anesthesia
where is epidural needle inserted
between L4 and L5 and into the epidural space (negative space)
what needle is used in epidural
Tuohy needle
-has the catheter inside (not outside)
how do you know if the epidural has gone into the vein
mother has metallic taste in mouth or goes tachy or has no lower limb movement within 3-5 min of test dose
types of nonpharmacologic pain management
hydrotherapy, application of heat and cold, hypnosis
types of nonpharmacologic management of discomfort
biofeedback, aroma therapy, intradermal water block
hydrotherapy key points
water on back (always fine)
laboring in warm water (fine if water is NOT broken)
why can women not labor in water once waters break
open to bacteria which opens the risk for infections
potential for baby to inhale fluid instead of air which can cause lung infections
heat does what to back
dilates
what is pudendal nerve block
an injection of a local anesthetic at the pudendal nerve root
what will pudendal nerve block not relieve
pain from uterine contractions
when should pudendal nerve block be administered
10-20 min before perineal anesthesia
why would a mother request a pudendal nerve block
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
the return of the uterus to a nonpreganant state after birth
involution process
when does involution begin
immediately after expulsion of the placenta with contraction of the uterine smooth muscle
24 hours after birth uterus is what size
same size as it was at 20 wks gestation
fundus descends at what rate
1 to 2 cm every 24 hrs
the uterus should not be palpable…
abominably after 2 weeks
when should the uterus return to its nonpregnant location
by 6 weeks after birth
nursing intervention post partum
- use to hand maneuver to check uterine tone
- firm fundus (no bleeding)
- empty bladder
- monitor VS
- monitor for blood loss
