T2 - Mgmt of Discomforts PPT (Josh) Flashcards
— is light stroking of abdomen or back in rhythm with the patient’s breathing during a contraction.
Effleurage
— is steady pressure applied to sacral area…Especially helpful when back pain is caused by the baby in the occiput posterior position…
Counterpressure
***Lifts the occiput off the nerves and provides some relief.
What is the purpose of Controlled Breathing Techniques?
Provides distraction and reduces perception of pain during UC
In 1st Stage, it increases size of abdominal cavity and promotes fetal descent
In 2nd Stage, it assists in bearing down by increasing abdominal pressure
How should they breathe?
iN through Nose
OUT through mOUTh
When is the Pant-Blo breathing used?
8-10 cm
s/e: can cause hyperventilation and Resp Alkalosis
What are S/E of Respiratory Alkalosis?
Lightheaded
Dizzy
Tingling of Fingers
Numbness/Blueness
***blow into paper bag or cupped hands
What breathing pattern is encouraged to reduce chance of Respiratory Alkalosis?
no more than 2 x’s the normal rate
When would we give butorphanol (Stadol)?
at top of contraction to increase perfusion to mom and decrease to baby
What determines the type of analgesia or anesthesia?
Stage/Phase and Progress of Labor
Why are Barbituates used?
to relieve anxiety and induce sleep
may be administers in early labor to alter a dysfunctional pattern
NOT used in active labor b/c of CNS depression in newborn
Which class of drugs are NOT used?
Benzos
- disrupt newborn thermal regulation
Examples of Pure Opioids
Hydromorphine (Dilaudid)
Meperidine (Demerol)
Fentanyl (Sublimaze)
Sufentanil (Sufenta)
Should Hydromorphine be given during labor?
Try NOT to give during active labor, but before is OK
Onset of — is almost immediate if given IV and 10-20 mins if IM.
Meperidine (Demerol)
***lasts 1.5 - 2 hrs
***not used as much b/c of effects on baby [sedation, neuro changes than can last 2-3 days]
When using Opioids, what should we have available for antidote?
Naloxone (Narcan)
***antagonist that reverses CNS depressant effects
***contraindicated for narcotic addicted patients b/c may precipitate withdrawal symptoms
What type of drug butorphanol tartrate (Stadol)?
Mixed Opioid Agonist-Antagonist
***Naloxone will NOT reverse effects
Which drugs provide adequate analgesia w/out respiratory depression in mom or baby?
Mixed Opioid Agonist-Antagonists
- butorphanol tartrate (Stadol)
- nalbuphine hydrochloride (Nubain)
What is one problem with Mixed Opiod Agonist-Antagonists like Stadol?
may precipitate withdrawal symptoms in narcotic dependent women and baby
Advantages of Epidurals
Patient remains alert
Good relaxation is achieved
Only partial motor paralysis
Airway reflexes remain intact
Gastric emptying is not delayed
Blood loss is not excessive
Disadvantages of Epidural
Limited Mobility
May increase duration of 2nd stage of labor
Not effective for some patients
Urinary retention
Pruritus (ithcing)
High/Total Anesthesia
Epidural blocks are a combination of — and —-
-caine’s and opiods
When would an Epidural be administered?
after labor is well established (5-7 cm)
Where is the Epidural Space?
outside the dura mater b/t the dura and the Spinal Column
Which vertebrae is the needle inserted through with an epidural?
L2-L5 (L3-L4 mostly)
Benefits of Epidural?
Airway remains intact
Only partial motor paralysis
Gastric emptying NOT delayed
Blood loss NOT excessive
Nursing actions w/ Epidural:
Why preload with IV fluids?
volume expansion to prevent maternal hypotension
expansion also increases size of epidural space
Nursing actions w/ Epidural:
Which position for needle insertion?
modified Sims or upright w/ back curved and legs dangling from bedside
- ‘Mad Cat’ or ‘Angry Shrimp’ position
Nursing actions w/ Epidural:
After needle insertion, which position should client be placed in?
side lying
- prevents supine hypotension
- helps distribute med evenly
Post Epidural Nursing Actions:
Assess maternal VS and FHR and O2 sat
Observe for bladder distention
Protect from injury
Assist woman to change position
Record response to meds
Monitor for adverse reactions
Complications from Epidural
Accidental injection into subarachnoid space (High Spinal)
Significant Hypotension
Post dural puncture headache
Infection
Why are High Spinals a concern?
can lead to respiratory arrest
What should we do if mother has a Hypotensive Episode in response to epidural?
Turn to lateral position or wedge hip
Increase IV rate
O2 by facemask (10-12 L)
Eleveate client’s legs (10-20 degrees)
Call Doc
Be prepared to administer vasoconstrictors (Ephedrine)
Nursing DX for Hypotensive Episode from Epidural.
Ineffective uteroplacental perfusion r/t maternal hypotension associated w/ epidural block meds
When would we expect to see a post dural puncture headache?
2 days after puncture and may continue for weeks
What causes relief from Post Dural Puncture Headache?
lie flat for 30 mins or less
How do we fix the Post Dural Puncture Headache?
Epidural Blood Path
- the most rapid, beneficial, and reliable relief measure for PDP headache
- woman’s blood is injected into the epidural space which creates a clot that patches the tear
- instantaneous pain relief
Besides Epidural Blood Patch, what are other treatments for PDP Headache?
Bedreast (lying flat)
Increase CAFFEINE (Mountain Dew and Excedrin)
Fluids (Oral or IV)
When is a Prudential Block used?
2nd and 3rd Stages of Labor and for repair of Episiotomy
***epidural block is suitable for all stages of labor and repair of episiotomy
Diff b/t Prudential Block and Epidural Block?
Prudintial block just blocks prudential nerve to pernieal area
Epidural block blocks all below L2-L5
When would a Prudential Block be administered?
late in 2nd stage of labor
***can also be administered during 3rd stage if episiotomy repair is necessary
Benefits of Prudential Block?
Doesn’t affect hemodynamic or respiratory functions
Doesn’t affect VS
Doesn’t affect FHR
What is a negative about Prudential Block?
urge to bear down is lessened or lost completely
no relief from UC (only for perineal area)
Which type of Anestheisia is used for birth and post delivery repairs and NOT for labor?
Prudential Block
What are advantages of a Spinal Block?
rapid pain relief w/o sedative effects
low incidence of adverse effects
What would a spinal block be good for?
C-section
Disadvantages of Spinal Block
Short duration
Postspinal headache
Increase incidence and degree of hypotension
Urine retention
Local Infiltration of Pernieum:
Why would epinephrine be given along w/ a ‘caine’ med?
to prevent excessive bleeding from episiotomy by constricting blood vessels
How is a Local Perineum injection given?
local anestetic (lidocaine) injected into skin and then SQ into region to be anesthetized
When would a General Anesthetic be used?
only if regional is contraindicated or if emergency situation develops
Fetal adverse reactions to General Anesthesia?
Resp. depression
Hypotonia
Lethargy
Examples of Inhaled General Anesthetics?
Nitrous Oxide
Halothane
Fluothane
Nursing actions w/ General Anesthesia
Oral antacids to neutralize gastric acid
Tilt the patient to displace uterus and keep IVC from being compressed
