Pain Management Flashcards
relieves anxiety and induce sleep
NOT used during labor for various reasons
sedatives
given by anesthesia (IV or IM opioid)
given due to epidural contraindication or if pt asks for it
systemic analgesia
what are the epidural contraindications that would cause systemic analgesia to be used
MRSA, spinal surgery, idiopathic thrombocytopenia
what is the opioid (narcotic) agonist analgesic
better pain relief (IV)
Fentanyl
what is the number one thing to remember with opioids
NEVER give 1 hr prior to delivery due to neonatal respiratory depression
what is opiod agonist-antagonist analgesic
Stadol and Nubain
**again watch for respiratory depression if given an hour before delivery
what negative side effects does Stadol have
hallucinations and dizzy
what negative side effects does Nubain have
similar to a morphine type response
what is the nursing PRIORITY when giving analgesic/opioids
SAFETY
what is the opioid antagonist
Narcan
describe Narcan nursing responsibility
always have available if giving opiod
**expect withdrawal response if given to drug user
what is the maternal opioid abstinence syndrome
withdrawing from opioids as a mother
what are the s/s of maternal opioid abstinence syndrome
yawning, runny nose, lacrimal tearing, sweating, dilation of pupils, anxiety, N/V/D, and **tremors
OR go straight into seizures
what is is important to remember with opiods and Narcan
use extreme caution
used for C section
given higher up in spine
spinal block
what is given for local perineal infiltration anesthesia and why
Lidocaine
perineum for repair after delivery
what is given for pudendal nerve block and why
Lidocaine injection in pudenal nerve
administered during second stage of labor for pain relief
*rarely given
when is Lidocaine injection given
second stage of labor OR 10-20 min before vacuum, episiotomy, delivery
spinal anesthesia compared to epidural block
spinal= C-section, blocks more (L3-L4), given higher up in spine epidural= vaginal, blocks less (L4-L5)
risks of spinal anesthesia(block)
postdural headache
epidural blood patch
what to do if spinal headache due to CFS leak
lay pt flat, pull blood from arm, inject blood into leak to form a clot (blood patch), and give fluids to prevent leak
this provides no uterine relief, only perineal relief
pudendal nerve
given in spinal column, below spinal cord
decreases pain during uterine contractions
epidural anesthesia
how is gravity used with epidural anesthesia
to bathe all nerves
ie/ if more relief felt on right side, catheter is probably leaning right so lay pt on left side to bathe nerves with medicine on left side
nursing interventions prior to epidural anesthesia
evaluate hx of spinal surgery evaluate skin for lesions evaluate CBC for platelet ct (want it >100,000) obtain consent for anesthesia *preload pt with NS/LR
what is the most important nursing intervention prior to epidural anesthesia
preload pt with 500 mL to 2 L of NS/LR
what is the most common side effect of epidural
hypotension due to sympathetic blockade
and vasodilation with pooling of blood in the lower extremities, decreased cardiac output
what is the target of the epidural
epidural space (negative space) do NOT go into spinal column, will lead to a CSF leak
what position to sit in during epidural administration
knee to chest position
sitting on side of bed (hunched over)
epidural anesthesia used to ______
keep pt awake
general anesthesia used to ____
put pt to sleep
