Nervous And Muscoskeletal Systems Flashcards
What changes to the pelvis
Levels of relaxin increase 10x in pregnancy
Relaxin targets the pelvic ligaments enabling the pelvis to expand - o accommodate for the gravid uterus annd the descending fetus during labour
Increasing levels of progesterone and oestroe also soften ligament by digesting collagen fibre chin increase mobility of pelvic joints
What causes pelvic girdle pain
Laxity and softening caused by relaxin, progesterone and oestrogen cause instability in the pelvic joints
Excessive instability and mechanical strain = pelvic girdle pain
What is the treatment for pelvic girdle pain
Pain relief, rest and low intensity movement
What ae the spinal changes
Gravid uterus + weight gain +change in entire of gravity mean that spine shifts to a slightly more posterior position accompanied by a slight lumbar lordosis - inward curve of the lumbar spine
Lower back pain is associated with joint instabili, increased mechanical strain and changing centre of gravity
What are the muscular changes in pregnancy
Abdominal muscles stretch due to gravity’s uterus less efficient at maintaining core stability and balance recovery
The distance between recuts abdominins widens
Splitting of the lines alba - connective tissue - btw were recuts abdomini =diastasis recti
What happens to balance
Instability of joint and change in centre of gravity and reduced core strength means postural instability
Increased risk of falls
What is the CNS change in pregnancy
Reduced volume of grey matter in cerebral cortex
Poor cognitive function in 3rd trimester
What is carpal tunnel syndrome
Compression f the median nerve in the carpa tunnel
Incidence increase x 15
Median nerve run along length of arm and goes through passage in the wrist - in controls the movement and feeling of the thumb and first three fingers
What are the symptoms of carpal tunnel syndrome
Tingling numbness and pain in the hand
What causes carpal tunnel yndrome
Oedoma
Haemodilution - blood is more watery and has relatively lessplasma proteins in it
Reduced colloid osmotic pressure
Water moves from the plasma to the interstitial space - outside the blood vessels
The soft issue becomes waterlogged which compresses the nerve against the bony arch
What is the local analgesia used in labour
Prudently block
What is pudendal block
Local anaesthetic - lidocaine- is injected bilaterally into the pudendal canal where the pudendl nerve is located via the vagina at the level of the ischial spine
Perineal infiltration
Prior to episiotomy and repair
Local anaesthetic is injected in a an shape into the perineum
What is the regional analgesia
Epidural
What is epidural
Insertion of epidural catheter consists of threading a needle between the bones and ligaments to reach a epidural space without going so far to puncture the dura matter
May be administered at any point of the spine but mostly on lumbar spine
Combination of local anaesthetic and strong opioid
Local anaesthetic blocks pain impules through nerves
Opioids block specific receptors in brain and spinal cord
Air or saline may be used to confirm placement in the epidural space
What is the midwifes role in epidural
Providing information
I’ve accesss
Gathering equipment
Supporting the women in the position
Clean the back
Communicating to the women
Preparing to dress the epidural site
Monitoring regularly blood pressure and fetal heart
Documentation - summary of event
How to monitor lady with epidural
Bloood pressure - 3x5 minutely then 30 minutely
Fetal heart rate - continuous for 30min
Bladder care
Administration and effects
Why check for the block in epidural
Make sure the block is
Covering area of incision and pain
Not too high or dense
How is the epidural block checked
Spinal nerves supply specific areas of skin
Sensitivity to changes in tel along the sensory dematmes can be used to assess the level of epidural block
Cold spray can be used
assess for movement in epidural
Excesssive motor weakness may indicates tooo high rate of epidural infusion, migration of the catheter into the dura or the formation of an epidural abscess or have atoms which require anaesthetic review and rapid treatment
Spinal regional anagelsia
Fine needle is used to insert local anaesthetic and opioid into the cerebrospinal fluid in the subarachnoid space
Inserted inferior LH to spinal cord
More faster acting than epidural 5 mins vs 25 mins
On dose administered
Affects whole body infertility to injection
Gives total sensory and motor block
