Pain Management Flashcards
Non pharmacological nursing interventions directed towards pain relief?
Providing information
Encouragement
Back rubs
Clean linens
Suggesting positional changes
Assisting with relaxation and breathing techniques
What are some pharmacologic agents that could be used to decrease discomfort and increase relaxation
Systemic analgesics
Regional nerve blocks (epidural)
Local anesthetic blocks
What is the goal of systemic analgesia during labor?
Provide maximal pain relief with minimal risk for the woman and fetus
What are some considerations before giving systemic analgesia?
Maternal assessment
- Vital sign stable
-No contraindications
- Accepting of risks and benefits
Fetal assessment
Labor assessment
Available routes
What are some examples of systemic analgesia for labor?
Sedatives
Narcotic analgesics
Nitrous oxide
What are sedatives used for?
Primarily used during early/latent phase of labor to promote relaxation and rest
What are some examples of sedatives?
Benzodiazepine (rarely used)
H-1 receptor antagonist:
- promethazine hydrochloride (phenergan)
- diphenhydramine (Benadryl)
When are narcotics used?
Often used during stage one/active phase to inhibit the transmission of pain impulses
What are some side effects of narcotics?
Respiratory depression, sedation, hypotension.
Can be reversed using the opiate antagonist naloxone (narcan)
What are some examples of narcotics?
Fentanyl
Nalbuphine
Morphine
Why is nitrous oxide considered a good option for pain relief?
Safe
Effective
Inexpensive
Self administered by patient as needed (patient hold mask tightly to face and inhales deeply to start flow of gas)
When is nitrous oxide contraindicated?
If patient has vitamin B 12 deficiency, such as with anemia, alcoholism, or anorexia
What is regional anesthesia?
Injection of a medication into an area that will reach nervous tissue and cause a temporary and reversible loss of sensation
Typically, highly effective in reducing pain sensations
What are common side effects of regional anesthesia?
Mild:
Vertigo, urinary retention, pruritis
Moderate:
Nausea, vomiting, hypotension
Severe reactions (rare):
Systemic toxicity, bradycardia, respiratory depression, convulsions, cardiac arrest
Nursing care for patients about to get an epidural, and after?
Ensure that IV is patent and preload IV bolus as ordered
Place monitors for vital signs and O2 saturation and FHR
Have O2 by face mask available for a patient during/after placement
Help position patient for epidural insertion
After injection, reposition patient to semi reclining with left uterine tilt
Monitor vital signs, be especially aware of FHR changes, or drop in mom‘s BP
Often, a urinary catheter is placed to drain the bladder
Adverse effects of spinal anesthesia
Similar to those for epidural:
-Hypotension
-Shivering
- Urinary retention
Also, a high block can occur, which affects respiratory muscles
Spinal headache can result from leakage of spinal fluid
What is a combined spinal - epidural most often used?
For patients with a cesarean birth
What are risks for general anesthesia?
Fetal respiratory depression
Maternal aspiration
Failure to establish patent airway
Precautions for general anesthesia
Typically, laboring women in the US are limited to clear liquid diet
If the woman is at high risk, she may be asked her remain NPO
Antacid administered to neutralize stomach contents in case of aspiration
Left tilt to displace uterus off of vena cava
Patent IV line
Pre-oxygenate for 3 to 5 minutes with 100% O2
Cricoid pressure by assistant during intubation
What are some nursing considerations after receiving general anesthesia?
After experiencing general anesthesia, a patient may need extra support when breast-feeding
- Due to decreased level of consciousness
- Due to the effect of anesthetic agents on the baby
- due to pain level
What are some considerations for preterm labor in regards to pain management?
Immature fetus has decreased ability to metabolize drugs
Avoid analgesia or limit to smallest possible dose
Avoid general anesthesia if possible
What are some considerations for preeclampsia regarding pain management?
A woman with mild preeclampsia may tolerate the analgesia or anesthesia of her choice
Severe preeclamptic patients at higher risk during both regional and general anesthesia (epidural preferred over spinal or general)
Hypotensive and hypertensive side effects can be more acute for this patient
Nursing considerations for patients with diabetes regarding pain management
Vulnerable to poor placental blood flow
Hypotension (a common side effect of regional anesthesia) can deplete blood flow to fetus even more
Important to use IV preload and careful positioning with left tilt to decrease chance of hypotension
Considerations for cardiac disease regarding pain management
Pregnancy can be risky for a patient with cardiac disease
With mitral stenosis, preferred anesthesia is epidural for a forceps assisted birth
Considerations for bleeding complications regarding pain management
Regional blocks contraindicated during active bleeding episodes due to potential for hypotensive episode
Scheduled cesarean with general anesthesia often recommended
What is the major adverse effect with an epidural?
Hypotension caused by vasodilation of the peripheral blood vessels and compression of the vena cava if patient is supine
How is hypotension prevented with patients with an epidural
Preloading with IV bolus as ordered
Careful repositioning of patient after
Placement with uterus tilted to left
