Pharmacological Pain Management: Sherpath

Question 1

Special Considerations When Medicating a Pregnant Woman

Answer 1

Cardiac output
Decreased respiratory capacity
Slowed peristalsis and decreased GI absorption
Analgesics may slow the progress of labor

Question 2

Analgesics

Answer 2

a drug that relieves pain. The opioid analgesics act on the CNS and alter the patient’s perception; they are more often used for severe pain. The nonopioid analgesics act primarily at the periphery, do not produce tolerance or dependence, and do not alter the patient’s perception; they are used for mild-to-moderate pain.

Question 3

General Anesthesia

Answer 3

the absence of sensation and consciousness as induced by various anesthetic medications, given by inhalation or IV injection.

Question 4

Nursing Considerations for Nitrous Oxide

Answer 4

Nurses should let women know that they may experience side effects of dizziness, nausea and vomiting, or dysphoria (Stewart & Collins, 2013).
Nurses should advise a laboring woman that the drug is a gas that must be inhaled through a mask.
The mask must have a demand valve so delivery of the drug stops while the patient is not inhaling.

Question 5

Antagonists

Answer 5

(in physiology) any agent, such as a drug or muscle, that exerts an opposite action to that of another or competes for the same receptor sites.

Question 6

Intrathecal Opioid Analgesics: Nursing Considerations

Answer 6

Does not cause maternal sedation.
Only a very small dose is needed.
Common side effects include nausea, vomiting, and pruritus.
Report side effects to anesthesia; have naloxone or naltrexone available.
Monitor for delayed respiratory depression depending on the drug given.
Observe and report nonreassuring fetal heart rate patterns.

Question 7

Systemic Opioid Analgesics: nursing Considerations

Answer 7

Assess women for drug use and dependence at admission to avoid mixing opioid agonist and antagonist drugs.
Monitor neonates for a delay in initiating or sustaining spontaneous respirations, respiratory rate < 30 breaths/min, and poor muscle tone.
Have naloxone available for newborns exposed to opioids during labor.

Question 8

Epidural Opioid Analgesics: Nursing Considerations

Answer 8

Do not give additional opioids or other CNS depressants except as ordered.
May be administered with nonsteroidal anti-inflammatory drugs.
Observe for delayed respiratory depression: Monitor respiratory rate, depth, oxygen saturation, and arousability hourly for 24 hr. Have naloxone available.
Notify anesthesia provider of a rate of <12 breaths per minute, persistent oxygen saturation of <95%, or difficulty arousing.

Question 9

Local Infiltration Anesthesia: Nursing Considerations

Answer 9

Local anesthetic: Used to numb perineum for episiotomy or laceration repair
Assess for drug allergies, especially to local dental anesthetics.

Question 10

Pudendal Block: Nursing Considerations

Answer 10

Local anesthetic: Used to numb the perineum and lower vagina; useful for instrument-assisted births
Assess for drug allergies, especially to local dental anesthetics.

Question 11

Agonists

Answer 11

a drug or other substance having a specific cellular affinity that produces a predictable response.

Question 12

A nurse is caring for a patient in the first stage of labor who received intrathecal opioid analgesics for pain relief from uterine contractions. The nurse observes for which common side effects of these drugs?

Answer 12

Pruritus: is a common side effect of intrathecal opioid analgesics. These drugs may be used throughout the first stage of labor and require only a very small dose injected into the subarachnoid space. These drugs allow the mother to feel her contractions, but not the pain.

Vomiting: is a common side effect of intrathecal opioid analgesics. These drugs may be used throughout the first stage of labor and require only a very small dose injected into the subarachnoid space. These drugs allow the mother to feel her contractions, but not the pain.

Nausea: is a common side effect of intrathecal opioid analgesics. These drugs may be used throughout the first stage of labor, and require only a very small dose injected into the subarachnoid space. These drugs allow the mother to feel her contractions, but not the pain.

Question 13

A woman in labor is given fentanyl for pain. Which vital sign is a priority for the nurse to monitor in the newborn infant?

Answer 13

Respiratory rate

Opioid analgesics can cause respiratory depression, which is more likely to occur in the newborn than in the mother, and respiratory rate should be monitored.

Question 14

A woman is administered fentanyl during labor and is still experiencing significant pain. Which order from the provider would the nurse anticipate for administration?

Answer 14

Nitrous oxide

The nurse anticipates an order for nitrous oxide, which can be administered to a woman who is still experiencing pain after the administration of fentanyl.

Question 15

Regional Anesthesia

Answer 15

for intrapartum analgesia, anesthesia, or both. These methods provide pain relief without loss of consciousness. Regional anesthesia includes epidural block, intrathecal (subarachnoid) opioid analgesic injection, subarachnoid (spinal) block and combined spinal-epidural anesthesia. The major advantage of regional pain management methods is that the woman can participate in birth yet still have good pain control. The woman usually feels some pressure and discomfort, although these sensations are greatly reduced.

Question 16

Contraindications: Epidural Block

Answer 16

Contraindications and precautions include the woman’s refusal, coagulation defects, uncorrected hypovolemia, an infection in the area of insertion or a severe systemic infection, allergy, or a fetal condition that demands birth sooner than the block can become effective.

Question 17

Maternal Hypotension: EB

Answer 17

An adverse effect of an epidural block is maternal hypotension. Sympathetic nerves are blocked along with pain nerves, which may result in vasodilation and hypotension. Intravenous fluids are administered prior to epidural insertion to reduce hypotension.

Question 18

Bladder Distention: EB

Answer 18

Bladder distention is another adverse effect of an epidural block. A woman’s bladder fills quickly because of the large quantity of IV solution, yet her sensation to void is reduced. Continuous or intermittent bladder catheterization is usually required, increasing risk of infection.

Question 19

Prolonged Second Stage: EB

Answer 19

The urge to push is often less intense with reduced sensation. Forceps- or vacuum extractor-assisted births are more likely because of the reduced urge to push.

Question 20

Migration of the Epidural Cath: EB

Answer 20

Migration of the epidural catheter is another potential adverse effect. The catheter may move after accurate placement. A woman may then have symptoms of intravascular injection, an intense block or one that is too high, absence of anesthesia, or a unilateral block.

Question 21

Fever: EB

Answer 21

Another adverse effect is a fever. Fever with no apparent infection may occur in a woman who has epidural analgesia, and its cause is not clear. The neonate’s temperature may be elevated as well possibly leading to unnecessary treatment for neonatal sepsis.

Question 22

Contraindications: Subarachnoid Spinal Block

Answer 22

Contraindications and precautions are similar to those for epidural block: the woman’s refusal, coagulation defects, uncorrected hypovolemia, infection in the area of insertion, systemic infection, allergy, or possibly prior spinal surgery.

Question 23

Averse Effects: SAB

Answer 23

Three adverse effects of an SAB are maternal hypotension, bladder distention, and spinal headache. Hypotension occurs because of sympathetic blockade as in epidural block but can be more severe. Treatment is the same, but a larger preload of IV fluid is common.

Postspinal headache may occur after SAB in some women because of cerebrospinal fluid leakage at the site of dural puncture. A spinal headache is postural; it is worse when a woman is upright and may disappear when she is lying flat. The incidence of spinal headache is lower if a small-gauge needle is used.

Question 24

Regional Anesthesia: Combined Spinal-Epidural Block

Answer 24

Rapid onset of pain relief without sedation
No motor block, enabling the woman to ambulate during labor (unless she receives a concurrent epidural block)
No sympathetic block, with its hypotensive effects
Dural puncture leads to potential for post-dural headache

Question 25

Vaginal Birth Anesthesia (Local Infiltration Anesthesia): Consideration

Answer 25

For cutaneous pain in the immediate area of an episiotomy or laceration
Rarely has adverse effects on either mother or infant
Does not alter pain from uterine contractions or from distention of the vagina
Performed by health care provider just before performing an episiotomy or suturing a laceration

Question 26

Vaginal Birth Anesthesia (Local Infiltration Anesthesia): Patient Teaching

Answer 26

There will be a short delay between anesthetic injection and the onset of numbness
It may burn before the anesthetic action begins

Question 27

Vaginal Birth Anesthesia (Pudendal Block): Considerations

Answer 27

Anesthetizes the lower vagina and part of the perineum before an episiotomy
Often used in anticipation of the need for an instrument-assisted vaginal birth
Risk of maternal complications including a toxic reaction to the anesthetic, rectal puncture, hematoma, and sciatic nerve block (if maternal toxicity is avoided, the fetus is usually not affected)
Does not block the pain from uterine contractions

Question 28

Vaginal Birth Anesthesia (Pudendal Block): Patient Teaching

Answer 28

The block is used to numb part of the vagina and perineum, but the mother will continue to feel pressure

Question 29

Aspiration pneumonitis

Answer 29

An inflammatory condition of the lungs and bronchi caused by inhaling foreign material or acidic vomitus.

Question 30

A nurse is caring for a patient who undergoes general anesthesia. Which adverse effects associated with general anesthesia should the nurse monitor for?

Answer 30

Uterine relaxation: The nurse should monitor for uterine relaxation, which is an adverse effect of general anesthesia.

Respiratory depression: The nurse should monitor for respiratory depression, which is an adverse effect of general anesthesia.

Maternal aspiration of gastric contents: The nurse should monitor for maternal aspiration of gastric contents, which is an adverse effect of general anesthesia.

Question 31

Which order would the nurse expect to administer to a patient at high risk for maternal hypotension prior to epidural anesthesia?

Answer 31

Intravenous fluids: The nurse would anticipate intravenous fluids, which should be administered prior to epidural anesthesia.

Question 32

A nurse is caring for a patient who has a contraindication for spinal anesthesia. Which is a contraindication for spinal anesthesia?

Answer 32

Infection at the site of insertion: Contraindications and precautions include the woman’s refusal, coagulation defects, uncorrected hypovolemia, infection in the area of insertion, systemic infection, allergy, or possibly prior spinal surgery.

Question 33

A patient experiences nausea and vomiting during labor. Which medication might the nurse anticipate administering?

Answer 33

Promethazine: The nurse would anticipate promethazine because it relieves the nausea and vomiting that may occur when opioid drugs are given.

Question 34

Which statement does the nurse use to describe to the patient’s partner why opioid analgesics are being administered?

Answer 34

“Opioid analgesics help the mother relax between contractions.”: The nurse explains that opioid analgesics affect the perception of pain, allowing the mother to relax during contractions.

Question 35

A patient has received fentanyl, and her respiratory status is rapidly declining. Which medication would the nurse anticipate administering to counteract the effects of this drug?

Answer 35

Naloxone: Naloxone counteracts opioid-induced respiratory depression.

Question 36

A patient arrives at the Labor and Delivery unit with steady contractions and is 5 cm dilated. On assessment, the fetal heart rate is 200 beats per minute, and it is determined that a cesarean delivery should be performed. Which anesthesia method does the nurse anticipate?

Answer 36

Subarachnoid (spinal) block: The nurse would anticipate a subarachnoid block (SAB), because it is recommended when a quick cesarean birth is necessary and an epidural catheter is not in place.

Question 37

Match the patient with the appropriate type of anesthesia.

Answer 37

Patient who requires a vaginal laceration repair after delivery
**Pudendal block
Patient in labor who would like pain relief and to be awake for the birth
**Epidural block
Patient who has an active skin infection on back and requires an emergency cesarean delivery
**General anesthesia
Patient in labor who would like to have pain relief but still feel contractions and be able to move
**Combined spinal-epidural anesthesia

Question 38

A nurse is caring for a patient who needs general anesthesia. What statement most describes this patient?

Answer 38

Patient refusing regional and local anesthetic methods and needs a cesarean delivery
A patient who refuses regional and local anesthetic methods and needs a cesarean delivery does require general anesthesia.

Question 39

A nurse is caring for a patient undergoing an episiotomy repair after birth. Which type of anesthesia does the nurse anticipate?

Answer 39

Pudendal anesthesia: The nurse would anticipate pudendal anesthesia for episiotomy repair. Pudendal blocks anesthetize the lower vagina and part of the perineum.

Local infiltration anesthesia: The nurse would anticipate local infiltration, which is routinely used for episiotomy repair. Local infiltration anesthesia numbs the immediate area of the episiotomy or laceration.