L&D Pain Management 2 Flashcards
Pharmacological methods of pain relief include (2).
To avoid slowing the progress of labor, prior to administering the nurse should assess?
Pharmacological methods of pain relief include analgesia and local/regional anesthetics. To avoid slowing the progress of labor, prior to administering analgesic pain relief, the nurse should verify that labor is well established by performing a vaginal exam that reveals a cervical dilation to be at least 4 cm with a fetus that is engaged.
Pharmacological Management:
Goal?
Analgesia include: (3)
Pharmacological Management ◯ Alleviates pain sensations or raises the threshold for pain perception ◯ Analgesia includes opioid analgesics epidural spinal regional analgesia
Sedatives (barbiturates) examples
Sedatives (barbiturates) such as
secobarbital (Seconal),
pentobarbital (Nembutal),
phenobarbital (Luminal) are not typically used during birth, but can be used during the early or latent phase of labor to relieve anxiety and induce sleep.
Sedatives (barbiturates)/Adverse Effects
Sedatives and pt pain?
Adverse effects of sedatives
X Neonate respiratory depression secondary to the medication crossing the placenta and affecting the fetus
X Unsteady ambulation of the client
X Inhibition of the mother’s ability to cope with the pain of labor.
Sedatives should not be given if the client is experiencing pain, because apprehension can increase and cause the client to become hyperactive and disoriented.
Sedatives (barbiturates)/Adverse Effects Client Education (2)
Client education
X Explain to the client that the medication will cause drowsiness.
X Instruct the client to request assistance with ambulation.
Sedatives (barbiturates): Nursing Actions (4)
Nursing actions
X Dim the lights and provide a quiet atmosphere.
X Provide safety for the client by lowering the position of the bed and
elevate the side rails.
X Assist the mother to cope with labor.
X Assess the neonate for respiratory depression.
Opioid analgesics:
1) Examples:
2) How they work?
3) Adm Route?
4) Best route during labor
1) Opioid analgesics such as meperidine hydrochloride (Demerol), fentanyl (Sublimaze), butorphanol (Stadol), and nalbuphine (Nubain)
2) act in the CNS to decrease the perception of pain without the loss of consciousness.
3) The client may
be given opioid analgesics IM or IV, but the IV route is recommended during labor because action is quicker.
4) IV route
Name 2 opioid analgesics that provide pain relief without
causing significant respiratory depression in the mother or fetus. Both IM
and IV routes are used.
Butorphanol (Stadol)
nalbuphine (Nubain)
Adverse effects of opioid analgesics (8)
Adverse effects of opioid analgesics
X Crosses the placental barrier; if given to the mother too close to the time of delivery, opioid analgesics can cause respiratory depression in the neonate.
X Reduces gastric emptying; increases the risk for nausea and emesis
X Increases the risk for aspiration of food or fluids in the stomach
X Sedation
X Tachycardia
X Hypotension
X Decreased FHR variability
X Allergic reaction
Opioid analgesics: Client Education (2)
Client education
X Explain to the client that the medication will cause drowsiness.
X Instruct the client to request assistance with ambulation.
Opioid analgesics: Nursing Actions (4)
☐ Nursing actions
X Prior to administering analgesic or anesthetic pain relief, the nurse should verify that labor is well established by performing a vaginal exam that reveals a cervical dilation of at least 4 cm with a fetus that is engaged.
X Have naloxone (Narcan) available to counteract the effects of respiratory depression in the newborn.
X Administer antiemetics as prescribed.
X Monitor maternal vital signs, uterine contraction pattern, and continuous FHR monitoring.
Antimetics (2)
Hint: P, H, V
Phenothiazine medications such as promethazine (Phenergan) or
hydroxyzine (Vistaril) can control nausea and anxiety. They do not relieve pain and are used as an adjunct with opioids.
Antimetics: Adverse effects
Adverse effects include dry mouth and sedation
Epidural and spinal regional analgesia consists of using analgesic
1) example of short-acting opiods
2) How does it work?
3) Where is it administered? (2)
4) Benefit (2)
Epidural and spinal regional analgesia 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. These opioids produce regional analgesia providing rapid pain relief
while still allowing the client to sense contractions and maintain the ability to bear down.
Adverse effects of epidural and spinal analgesia (6)
☐ Adverse effects of epidural and spinal analgesia
X Decreased gastric emptying resulting in nausea and vomiting
X Inhibition of bowel and bladder elimination sensations
X Bradycardia or tachycardia
X Hypotension
X Respiratory depression
X Allergic reaction and pruritus
Epidural and spinal analgesia: Client education (1)
Client education
X Provide the client with ongoing education related to expectations for procedure.
Epidural and spinal analgesia: Nursing Actions (5)
Nursing actions
X Institute safety precautions, such as putting side rails up on the client’s bed. The client may experience dizziness and sedation, which increases maternal risk for injury.
X Assess the client for nausea and emesis and administer antiemetics as prescribed.
X Monitor maternal vital signs per hospital protocol.
X Monitor for allergic reaction.
X Continue FHR pattern monitoring.
Pharmacological Anesthesia
◯ Pharmacological anesthesia eliminates?
◯ Anesthesia used in childbirth includes? (2)
■ Regional blocks are most commonly used and consist of pudendal block, epidural
block, spinal block, and paracervical nerve block.
Pharmacological Anesthesia
◯ Pharmacological anesthesia eliminates pain perceptions by interrupting the nerve
impulses to the brain.
◯ Anesthesia used in childbirth includes regional blocks and general anesthesia.
■ Regional blocks are most commonly used and consist of pudendal block, epidural
block, spinal block, and paracervical nerve block.
Pharmacological Anesthesia: Regional blocks
1) Common? or uncommon use?
2) Examples (4)
Pharmacological Anesthesia
■ Regional blocks are most commonly used and consist of pudendal block, epidural block, spinal block, and paracervical nerve block.
Pharmacological Anesthesia: Regional blocks
Pudendal Block:
1) Examples
2) Adm route
3) Benefit?
4) Areas that are numb
5) Used for procedures such as (3)
6) Administered when (what stage)?
7) Used for procedures such as (nonstandard) (2)
1) Pudendal block consists of a local anesthetic such as lidocaine (Xylocaine)
or bupivacaine (Marcaine)
2) being administered transvaginally into the space
in front of the pudendal nerve.
3) This type of block has no maternal or fetal
systemic effects,
4) but it does provide local anesthesia to the perineum, vulva, and rectal areas
5 )during delivery, episiotomy, and episiotomy repair.
6) administered during the second stage of labor 10 to 20 min before delivery
7) providing analgesia prior to spontaneous expulsion of the fetus or forceps assisted or vacuum-assisted birth.
☐ Adverse effects of pudendal block
X Broad ligament hematoma
X Compromise of maternal bearing down reflex
☐ Nursing actions
X Instruct the client about the method.
X Coach the client about when to bear down.
X Assess the perineal and vulvar area postpartum for hematoma.
Pharmacological Anesthesia: Regional Blocks
Pudendal Block: Adverse Effects (2)
Adverse effects of pudendal block
X Broad ligament hematoma
X Compromise of maternal bearing down reflex
Pharmacological Anesthesia: Regional blocks
Pudendal Block: Nursing Actions (3)
Nursing actions
X Instruct the client about the method.
X Coach the client about when to bear down.
X Assess the perineal and vulvar area postpartum for hematoma
Epidural Block
Pharmacological Anesthesia: Regional Blocks
1) 2 step
2) Local eg?
3) Epidural med eg? (2)
4) Injected where?
5) Result?..Where is sensation lost
6) Relieving the discomfort of (4)
7) Adm when?
8) What type of infusion?
An epidural block consists of a local anesthetic bupivacaine (Marcaine) along
with an analgesic morphine (Duramorph) or fentanyl (Sublimaze)
4) injected into the epidural space at the level of the fourth or fifth vertebrae.
5) This eliminates all sensation from the level of the umbilicus to the thighs,
6) relieving the discomfort of uterine contractions, fetal descent, and pressure and stretching of the
perineum.
7) It is administered when the client is in active labor and dilated to at least 4 cm.
8) Continuous infusion or intermittent injections may be administered through an indwelling epidural catheter. Patient-controlled epidural analgesia is
a new technique for labor analgesia and is becoming a favored method of acute
pain relief management for labor and birth.
Epidural Block: Adverse effects of epidural block (4)
Pharmacological Anesthesia: Regional blocks
Adverse effects of an epidural block X Maternal hypotension X Fetal bradycardia X Inability to feel the urge to void X Loss of the bearing down reflex
