Labor and delivery 3 Flashcards
comfort measures used in the management of labor pains
- Keep patient informed of the plan of care and why this is the plan of care. Explain the fetal monitoring strip and how it is interpreted.
- let them know they are in good hands, and help keep a calm environment.
- Explain the pain management options available before the patient needs them
- Frequent repositioning, ambulating, birthing ball, leaning over (against partner, bed, wall, etc.), showers/baths, breathing techniques, visualization/relaxation techniques, prayer/meditation, massage, counter-pressure during contractions (hips), aroma therapy, hypnosis, and moaning (dark tones), etc
- involve the support person and show them what to do and how to best support their loved one.
Review breathing techniques use in management of labor- Lamaze
- first level is slow paced
- second level is modified paced
- third level is pattern paced, abdominal breathing
- quick method.
When would opiate analgesics be used to control labor pains
IV pain medication is ideal for the woman not wanting a natural birth but cannot have an epidural or would like to wait to get the epidural
What are the specific opiates used?
Stadol, Nubain, Demerol, and Fentanyl
What are the contraindications for opiates
Known allergies, history of substance abuse
-Do not administer if your fetal heart rate is non-reassuring (category II or III) because it will only get worse
What are the contraindications for stadol
chronic HTN/Preeclampsia
What are the contraindications for demorol
convulsive d/o, undiagnosed acute abdo pain
What is the main impact if opiates are given too early in labor
They will not work as well later when her pain is too much and she needs real relief
-if not in real labor (active labor) contractions will stop which is a good thing if she is preterm but can be frustrating if she is closer to her due date and wants to be delivered.
What is the main impact if opiates are given too late in labor
-infant will be drowsy (decreased apgars, decreased respiratory effort, and low tone, which may lead to the need for NRP to be initiated).
What is the opiate antagonist
Naloxone (Narcan).
What are the nursing responsibilities prior to administration of an epidural-7
obtain all needed supplies, prepare the patient, obtain consents, pre-medicate (anti-acid and LR fluid bolus), notify anesthesia that the patient is ready for her epidural and give a short report, obtain baseline vital signs, and ask all visitors except for one support person to remain
nursing responsibilities During an epidural and after?-4
During- assist the patient into the proper position while it is being placed and afterwards while being taped up
- closely monitor vital signs during the procedure and after (Q 5 minutes and then Q 15minutes)
- easing patient’s anxiety (praising her for doing a good job maintaining the uncomfortable position and being still, talking her through the process so she knows what is about to happen and how much longer until we are done, etc.)
- help cope with pain (contractions, placement) with breathing techniques and encouragement
What is the relationship between blood pressure and epidurals
medication used are a vasodilator which causes the maternal blood pressure to drop which affects mother (nausea, vomiting) and affect the fetus (non-reassuring fetal heart tones).
How is a decrease in blood pressure treated
- prevention->administering a fluid bolus before the procedure
- treatment->administer an additional fluid bolus depending on how much was given the first go around and depending on the woman’s history (cardiac, BP, etc.)
- Interventions for non-reassuring fetal heart tones would be the same (turn from side to side, bolus, stop Pitocin, start O2) while you are addressing the low blood pressure cause
What drug is used if the woman’s blood pressure does not recover after initial measures have been implemented
Ephedrine
What is the difference between an epidural and spinal anesthesia-2
- the actual injection location
- epidural space
- spinal canal - Epidural is used in a vaginal delivery situation
- spinal block is used in a surgery situation
How are epidural/spinal managed medically-5
-vital signs, assess dermatone level (ensure they can breathe), assess for pain level, Assess if patient is able to push effectively (too numb). Continue to assess labor progress and fetal strip.
What is the difference in nursing care between spinal and epidural
- Both patients should receive adequate education before the procedure, during, and after recovery. The patient is not allowed to ambulate
- Labor nurse cares for the laboring patient with an epidural
- OR/PACU nurse cares for the spinal block patient
What is the nursing care associated with general anesthesia-before-8
Educate, prep patient for surgery per policy, administer anti-acids (i.e. bicitra, pepcid), baseline vitals, bolus fluid, ensure type/screen is completed, platelet count, prime/hang antibiotics but keep clamped
What is the nursing care associated with general anesthesia-after-7
Educate, assess pain level, respiratory assessment, manage pain (keep a close eye on respirations), assess return of sensations (dermatone level), and since this is a postpartum mom you need to assess bleeding (weigh do not eye guestimate the weight), fundal assessment
Fetal implications associated with general anesthesia-4
Assess fetal strip, Ensure mother is positioned with on a tilt (bump under hip to relieve vena cava pressure from uterus), note infant may be drowsy after delivery due to general anesthesia and may need NRP initiated. Have NICU RT and a NICU nurse present during delivery
What is a cervical ripening procedure
used when inducing (initiating/starting) labor and the woman’s body is not ready
-Patients who are induced with a soft/ripe/thinner cervix will skip this ripening step and they have a better outcomes
What medications are used for cervical ripening
Prostaglandins-cytotec (misoprostol), cervidil
What are the major nursing responsibilities when ripening the cervix
- have a reassuring fetal strip before administering any medicatio
- depending on the route of administration the patient may have to maintain a specific position
- more frequent vitals, keep a close eye on contraction frequency since the patient may experience tachysystole, monitor the fetal strip
