Pain Jeopardy

Question 1

N.N. is 5 cm dilated and would like an IV medication to help with the pain of labor. What are 3 things you can tell the patient about the effects of a narcotic on the patient and the fetus/newborn?

Answer 1

• All systemic medications cross the placenta (Cross by simple diffusion)
• They can make the patient and the baby sleepy: They can decrease FHR variability in labor
• They can cause newborn respiratory effort especially if given close to birth
• They do not take all the pain away but can take the edge off

Question 2

When should IV pain medications be used in labor?

Answer 2

IV medications should be given during the contractions because there is less transfer of the medication to the fetus

Question 3

Is Tylenol or ibuprofen better for postpartum cramping with involution? Why?

Answer 3

Ibuprofen: they are prostaglandin inhibitors and block thromboxane, which contributes to increased endometrial cramping

Question 4

N.N. received a narcotic 20 minutes ago and just delivered the baby. What effects might you note in the baby from that medication and what would you give to treat it?

Answer 4

*Neonatal CNS depression- respiratory depression

*Narcan (naloxone hydrochloride) 0.1 mg/kg IV, ET, IM

Question 5

N.D. has a history of heroin and PO opioid drug abuse. The patient is about to deliver a baby. Why should Narcan (naloxone) not be used for respiratory depression in this newborn?

Answer 5

Naloxone should be avoided because of the likelihood of precipitating and intensifying withdrawal symptoms (potentially seizures).

Also should not be used in a newborn born to a mother on methadone maintenance for the same reason

Question 6

What is specific about nubbin r/t withdrawal?

Answer 6

Nubain can precipitate withdrawal in drug addicted patients because they reverse the analgesic effects of other opioids or narcotics

Question 7

How long does it take for epidurals to onset?

Answer 7

up to 30 minutes

Question 8

List 3 common minor side effects of the epidural/spinal and 1 comfort measure for each

Answer 8

itchy skin: ice/cold compress, nubain, zofran

• nausea and vomiting: zofran

-slight increase in temperature: fluids, cold compress

Question 9

E.A. received an epidural and now has relief only on one side of the body. Is this normal and what can you do to help this patient?

Answer 9

• One sided blockade is one complication that can occur with epidural anesthesia and probably due to inadequate spread of local anesthetic within epidural space
• Place E.A. on the side that is un-anesthetized which allows for the nerves to be bathed with the anesthetic or put patient in a more neutral position
• Call anesthesia. Sometimes they can readjust the catheter

Question 10

E.A. received an epidural 20 minutes ago and now the blood pressure is 75/40. What effect might you see in her fetus and what are two nursing actions you may do to correct her hypotension?

Answer 10

Fetal Effect:

*Late decelerations

*Prolonged decelerations

Nursing Actions

1) IV fluid bolus

2) Position change

3) Call anesthesia for ephedrine or phenylephrine

Question 11

What position is recommended for a spinal HA?

Answer 11

stay horizontal vs upright

Question 12

Three hours ago S.A. received a spinal and now is complaining of an itchy nose, neck, and chest.

What are you going to tell this patient about these side effects and what is one medication that can be used to treat it?

Answer 12

*Common side effect

*Medications:

• Benadryl 25-50 mg (PO/IV/IM) q 6 hrs.
• Naloxone (Narcan) may be used because it displaces morphine-like drugs from receptor sites on the neurons
• Nubain: effective against neuraxial- induced itching

Question 13

Everything Else for 200
Reveal Correct Response Spacebar
S.S. is a G1P0 at 39w4d who has been in and out of l & D two times during your 12 hr. shift. Each visit the cervix is 1 cm. The patient is exhausted from 2 days of contractions. What 2 medication management options can you offer this patient and why?

Answer 13

Prodromal labor
- Benadryl 25-50 mg and go home and sleep

• Ambien 5-10 mg p.o -discharge home to sleep
• Morphine Sulfate 10 mg IM and phenergan 12.5-25 mg PO > d/c home or 10 mg IM and 2 mg IV with phenergan and morphine sleep in hospital

Benefits of Sedative use in prodromal labor

*Decreased anxiety

*Allows for rest- often wake up after several hours sleep in active labor OR was not in labor and the contractions have resolved

Question 14

Everything Else for 200
Reveal Correct Response Spacebar
S.S. is a G1P0 at 39w4d who has been in and out of l & D two times during your 12 hr. shift. Each visit the cervix is 1 cm. The patient is exhausted from 2 days of contractions. What 2 medication management options can you offer this patient and why?

Answer 14

Prodromal labor
- Benadryl 25-50 mg and go home and sleep

• Ambien 5-10 mg p.o -discharge home to sleep
• Morphine Sulfate 10 mg IM and phenergan 12.5-25 mg PO > d/c home or 10 mg IM and 2 mg IV with phenergan and morphine sleep in hospital

Benefits of Sedative use in prodromal labor

*Decreased anxiety

*Allows for rest- often wake up after several hours sleep in active labor OR was not in labor and the contractions have resolved

Question 15

E.E. is now 4 cm dilated and is requesting something for pain. The patient has been vomiting for the last two hours. Other than the pain medication what else might you give this patient and why?

Answer 15

*Zofran 4-8 mg (IV)– most common

*Phenergan 25-50 mg IM or PO mg

Question 16

You have been caring for GA all shift. The patient is having an emergency c-section under general anesthesia. You know that the potential complications of general anesthesia include:

Answer 16

A. Fetal depression that is directly proportional to the depth and duration of the anesthesia

C. Uterine relaxation that causes increased blood loss

E. Slower initiation of bonding and breastfeeding