Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6903 > OB caring for pt w labor epidural > Flashcards

OB caring for pt w labor epidural Flashcards

1
Q

An epidural is important for blunting the HD effects from contractions in what sub populations?

A

mitral stenosis, spinal cord injury, intracranial neuro vascular lesions, preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Absolute contraindications for laboring epidural?

A

refusal, uncooperative, increased ICP, infection at site of needle placement, frank coagulopathy, severe hypovolemia, anticoag therapy, decreased FHR variability or late decels, known allergy to med given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Relative contraindications to laboring epidural?

A

systemic maternal infection, preexisting neuro deficiency, mild or isolated coagulation abnormalities, relative hypovolemia, poor staffing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Moving towards the spinal cord from the epidural space, what are the 4 membranes that cover the spinal cord going from outermost to innermost?

A

dura, arachnoid, subarachnoid, pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

This is the outermost layer covering the nerve roots

A

dura mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

This layer is thin, spider like and forms the middle layer

A

arachnoid mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

This layer beneath the arachnoid matter and filled w CSF?

A

subarachnoid mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

This is the innermost layer and adheres tightly to the spinal cord and brain

A

pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When opioids and LA are used for epidurals, they collect in?

A

the fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Epidural space contains?

A

fat, epidural veins, lymphatics, segmental arteries, nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Medications used in epidurals act on receptors in the?

A

dorsal horn by diffusing across meninges and CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

C6 dermatome?

A

thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

C8 dermatome?

A

ring/little finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T 4 dermatome?

A

nipple line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T6 dermatome?

A

xiphoid line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T 10 dermatome?

A

umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S2, S3, S4 dermatome?

A

perineal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Poss situations causing inadequate pain coverage w epidural placement?

A

BMI >30, short or tall, previous spinal surgeries, variety of musckuloskeletal disorders, hx of previous epidural, radicular pain during placement, posterior presentation of the fetus, labor >6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

some troubleshooting suggestions for unsatisfactory labor epidural?

A

manipulate epidural catheter, add more LA, reposition, replace epidural, single shot spinal, continuous spinal, combined spinal epidural, place additional epidural, IV meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Some causes of an adequate level but insufficient density of block?

A

not enough time, loss of LA (volume), inadequate % of LA, pt overexpectations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Some causes of satisfactory density but inadequate segmental level?

A

small vol of LA, insufficient time, loss of LA, anatomical features such as previous surgery, allow more time, additional epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of not working epidural that had been working?

A

migration in to subarachnoid space (total spinal), intravascular, laterally (unilat block), completely out, labor progression, dysfunctional labor, pt perception changed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If pt has a lateral/one side block, what is something you can try?

A

have patient lie painful side down and bolus while lying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can you do to troubleshoot an epidural that was working and is currently not?

A

catheter exam, redose, give more volume, add opioids, % LA, replace

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Epidurals are typically placed at what level?

A

L3-4, L4-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

T10-L1 innervates what organs?

A

uterus, cervix, upper portion of vag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

S2-S4 innervates what part of body?

A

perineum

28
Q

First stage labor pain is visceral or somatic?

A

visceral

29
Q

Second stage labor pain is visceral or somatic?

A

somatic

30
Q

Epidural infusions tend to go up or downward more readily?

A

upward

31
Q

Why are the nerve fibers for the 2nd stage of labor harder to reach?

A

further from tip of epidural catheter, larger in diameter, thicker dura

32
Q

A pt w this has increased epidural failure?

A

chronic back pain

33
Q

Pt’s w unilateral sciatica of the affected nerve become blocked how much later than nerves on the contralateral side?

A

10-70 min later

34
Q

ASA rec on antiplt drugs?

A

should be stopped before epidural and measure INR/PTT

35
Q

ASA rec on plavix?

A

does not increase the risk of spinal hematoma

36
Q

ASA rec on fibrinolytic or thrombolytic drugs?

A

extreme caution should be used when placing epidural or spinal in these pts

37
Q

ASA: SQ hep?

A

not contraindicated. give SQ hour after epidural or spinal placement, remove catheter one hour before SQ hep given or 2-4 hours the last dose

38
Q

ASA on LMWH?

A

places pt at increased risk of spinal hematoma. in extreme cases when must have spinal/epidural spinal must be dosed 10-12 hours after last dose of LMWH, remove catheter prior to starting LMWH 10-12 hours after the last dose of LMWH given w subsequent doses given at least 2 hours after catheter removed

39
Q

What influences and opioids onset and duration of action in epidural?

A

lipid sol

40
Q

Lipid sol opioids have a what duration and onset of action?

A

short duration, fast onset of action (fent, meperedine)

41
Q

Highly lipid sol drugs have a short mechanism of action in epidural d/t?

A

rapid vascular absorption and slow rostral diffusion in CSF, elimination occurs at the arachnoid granulations

42
Q

2 opioids that are hydrophilic?

A

morphine and hydromorphone

43
Q

Hydrophilic opioids have what onset of action and duration?

A

slower onset, longer duration

44
Q

Do hydrophilic or lipid sol drugs have a greater dermatological spread providing analgesia to larger areas?

A

lipid sol

45
Q

Onset and duration of action of fent in epidural?

A

5 min; 4-6 hours

46
Q

Onset and duration of action of meperdine in epidural?

A

5-10 min; 6-8 hours

47
Q

Onset and duration of action of hydromorphone in epidural?

A

15-30 min; 6-18 hours

48
Q

Onset and duration of action of morphine in epidural?

A

30-60 min; 6-24 hours

49
Q

Why do you have to be especially careful with hydrophillic opioids in epidural?

A

cause resp depression soon after admin and delayed like 24 hours after admin

50
Q

Lipid sol or hydrophillic meds are more likely to spread rostally?

A

hydrophillic

51
Q

Should the pt be on po opioids if had them in epidural?

A

no

52
Q

Why are pts at greater risk of N/V when received opioid in epidural?

A

rostral spread of opioid in CSF to chemoreceptor trigger zone in brainstem

53
Q

It is postulized that itching caused by opioids in epidural is caused by?

A

alterations in spinal and trigeminal nerve processing. the modulation of nociceptive input is interpreted at a higher level as an itch

54
Q

What is a treatment for the itch from opioids in epidural?

A

nubaine: mixed agonist/antagonist that antagonizes the mu opioid kappa receptors which produce analgesia

55
Q

What will produce a motor block?

A

increased volume and higher percent of LA in to epidural space

56
Q

This LA provides the best sensory block w minimal motor block?

A

ropiv

57
Q

Ropiv is also commonly used for what 2 reasons?

A

quick onset w long duration of action

58
Q

Systemic LA side effects?

A

lightheadedness, dizzy, metallic taste, ringing in the ears, shivering, muscle twitching, tremors, convulsions, CNS depression and resp arres, hypotension

59
Q

Pt should be positioned for epidural how?

A

sitting laterally w knees and back flexed

60
Q

Fent 2mcg/mL/Ropivacaine 0.2% NaCl 0.9%: min and max continuous dose and appropriate bolus dose?

A

min: 8mL/hr; max: 14 mL/hr; bolus: 4 mL, max 3 bolus doses in an hour; max 1 hour limit= 26 mL

61
Q

Can a person eat w epidural?

A

clear liquid only

62
Q

What does the baby have to have during epidural placement?

A

FHT tracing before placement and continuously after placement if poss

63
Q

Pulse ox should be used when following epidural placement?

A

continuously during test dose and initial bolus period, record at least q hr after that

64
Q

BP should be recorded how often after epidural placement? After a bolus, the BP should be obtained how often?

A

q5 min x 4, q15 min x 2, q 30 min thereafter if stable/ q5 min x 4 after bolus

65
Q

Once an hour, what should be recorded?

A

dermatome level, RR, pain score, sedation score

66
Q

Q4 hours what should be recorded?

A

total vol of epidural med

6903 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions