Intrapartum Pain Management

Question 1

VS, FHT’s and contractions during labor are taken at what intervals:

1) Latent
2) Active
3) Transition/Second Stage

Answer 1

1) 30-60 min
2) 30 min (FHTs q 15-30 min)
3) 15 min

Question 2

How often should a woman in labor empty her bladder and why?

Answer 2

q 2 hrs because a full bladder can slow labor

Question 3

COMFORT MEASURES: Cognitive Strategies

Answer 3

• Dick Read: conscious relaxation & breathing
• Lamaze
• Bradley (partner coached)
• Hypnosis/Hypno-Birthing

Question 4

Systemic Analgesia: First Stage Opiods?

Answer 4

• Morphine
• Meperidine (Demerol)
• Butophanol (Stadol)
• Nalpbuphine (Nubain)
• Fentanyl
• PUT BOTH SIDE RAILS UP AFTER ADMINISTRATION

Question 5

Systemic Analgesia: First Stage Antiemetics

Answer 5

• usually given w/ Opioids
• Vistaril
• Phenegran
• Compazine

Question 6

Effects of Analgesics on the fetus?

Answer 6

decreased variability of FHT’s

Question 7

Effects of Analgesics on the newborn?

Answer 7

Decreased attention, social responsiveness & breast feeding initiation

Question 8

Types of OB Anesthesia?

Answer 8

• local
• pudendal
• regional (epidural)
• spinal
• general

Question 9

Effects of Analgesics on the Mother?

Answer 9

• Diminishes pain perception
• May effect progress of labor (timing)
• Relaxation
• Drowsy
• Transient hypotension
• N&V
• Dry mouth
• Respiratory depression
• Disappointment, failure of expectations

Question 10

Maternal A/E’s from regional (epidural) anesthesia?

Answer 10

• Transient hypotension (fetal bradycardia)
• Urinary retention
• Pelvic relaxation
• Risk of injury
• Loss of urge to push (increased chance of operative birth)
• Itching
• Elevated Temperature
  
  • need fetal & septic work up

Question 11

What are the most common pain meds given during labor?

Answer 11

• Butophanol (Stadol)

- Nalpbuphine (Nubain)

Question 12

The “Cascade of Interventions” needed after an epidural include?

Answer 12

IV, CEFM, foley, bedrest, limit position choices

Question 13

Nursing Care: Prior to Epidural

Answer 13

• Informed consent
• Instruct patient
• IV preload with 500-1000 ml of dextrose-free solution (bolus) Lactated Ringers
• Monitor fetus
• Monitor VS

Question 14

Nursing Care: During epidural

Answer 14

• Support in sitting or side-lying position with back arched outward, shoulders rolled, hips even during procedure.
• Assist patient to remain still
• Assist with breathing
• Emotional support

Question 15

Nursing Care: Following an epidural

Answer 15

• Position of left side or back with left tilt
• Observe for signs of systemic administration
• Monitor maternal VS
• Monitor fetus
  O2 available as needed, 7-10 l/min

Question 16

Maternal VS should be monitored how often following an eipdural?

Answer 16

Q 2 min x 5, then Q 5 min x 3, then Q 15 in x 3

Question 17

Nursing Care: Ongoing care following an epidural

Answer 17

• Check bladder q 1h
• Cath (or indwelling cath) q 2h or as needed
• Position with good alignment. Watch for pressure points. Change position.
• Watch for signs of labor progress.
• Assist with pushing.
• Perineal dose sometimes administered for delivery.

Question 18

Maternal dangers from general anesthesia?

Answer 18

aspiration & bleeding

Question 19

Fetal dangers from general anesthesia?

Answer 19

respiratory depression