pain measures during labour

Question 1

what is the goal of pharmalogical pain measures during labour?

Answer 1

-to provide maximum pain relief with minimum risk to mom and fetus

Question 2

what is important to remember about drugs given during labour?

Answer 2

• all systemic drugs used in labour cross the placental barrier by simple diffusion
• drug action in the body depends on rate substance is metabolized in liver
• fetus has inadequate ability to metabolize analgesics

Question 3

why is morphine better in early labour than later?

Answer 3

longer half life than fentanyl and so increased risk of respiratory depression on infant after delivery if used later

Question 4

what is the major risk of nitrous oxide during labour?

Answer 4

of inadvertant general anesthesia if not self administered and adequate breaks taken between contractions

Question 5

what are some possible side effects or complications related to an epidural?

Answer 5

• hypotension leading to fetal bradycardia
• unanticipated spinal injection, can cause serious post-spinal headache
• bladder dysfunction
• inability to ambulate/move
• reduced ability to push
• pruritis
• tremors
• nausea/vomiting
• neurological complications
• could fail to block

Question 6

what is a pudenal block?

Answer 6

it is a local anesthesia injected into pudendal nerve

affects lower vagina, vulva, and perineum

no affect on fetus or progress of labour

can cause hematoma, perforation of rectum, trauma to siatic nerve

Question 7

when is general anesthesia used in labour?

Answer 7

only in emergent situations because it is higher risk

can cause fetal depression, uterine relaxation, there is a risk of vomiting and aspiration and difficulty intubating

Question 8

what is involved in nursing care for an epidural?

Answer 8

-baseline vitals and FHR
-IV access
-support and attend to person during insertion
-BP and HR q5min x 20 after insertion
-continuous RN presence
-assess sensory level q30-60min
-assess motor function q1h and whenever pt is getting up
-attend to bladder function (aid with getting to washroom, cath as needed)
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Question 9

during the second stage of labour, what level of dermatomes should be affected by an epidural

Answer 9

S2-S4 (pudendal nerves, somatic)

Question 10

during first stage of labour, what level of dermatomes should be affected by an epidural?

Answer 10

T10-L1 (sympathetic fibers)