UNIT 3 PAIN MANAGEMENT EPIDURAL DURING PREGNANCY CHAPTER 14

Question 1

Nonpharmacological management of pain

Answer 1

Relaxation
-Positioning

-Thermal stimulation(warm towels, NEVER HOT WATER OR HOT BATH
-Warmed blankets, warm compresses, heated rice bags, a warm bath or shower, or a moist heating pad can enhance relaxation and reduce pain during labor.
-Cold application such as cold cloths, frozen gel packs, or ice packs applied to the back, the chest, and/or the face during labor may be effec- tive in increasing comfort when the woman feels warm.
-Heat and cold may be used alternately for a greater effect. Neither heat nor cold should be applied over ischemic or anesthetized areas because tissues can be damaged (Collins, 2017). One or two layers of cloth should be placed between the skin and a hot or cold pack to prevent damage to the underlying integument.

-Sacral pressure
-Effleurage (light massage) and counterpressure have brought relief to many women during the first stage of labor. circular massage

Diversion/Distraction
-Guided imagery
-Focal point
-Music

 Breathing

Question 2

What is the nurses role with nonpham pain interventions for patients

Answer 2

Determine if patient has taken childbirth classes-
 Minimize environmental stimuli- try not to over stimulate pt
 Assess pain level: 0-10

Question 3

Pharmacological Narcotics measures for pain relief

Answer 3

 IV Narcotics- opioids
-Demerol
-Stadol

 Assess dilation before administration (not given
during transition phase)

 May cause respiratory depression in the neonate

 Narcotic antagonist (Narcan) available to reverse
respiratory depression

watch vitals very closely

NOTE** Do NOT use in mothers who are drug
dependent, will cause withdrawal symptoms in mother and/or neonate

Question 4

What is Local anesthetic used for

Answer 4

Local infiltration
-used to numb the perineal area for episiotomy
-no side effects unless mother is allergic

Local perineal infiltration anesthesia may be used when an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia. Rapid anesthesia is produced by injecting approximately 10 to 20 mL of 1% lidocaine or 2% chloroprocaine into the skin and then subcutaneously into the re- gion to be anesthetized. Epinephrine often is added to the solution to localize and intensify the effect of the anesthesia in a region and to prevent excessive bleeding and systemic absorption by constricting lo- cal blood vessels. Injections can be repeated to keep the woman com- fortable while repairs following birth are completed.

Question 5

Regional Anesthesia, what does it consist of

Answer 5

Regional anesthesia
-Epidural- labor/CS
-Spinal- C/S
p374, box 14-6 S/E of
epidural and spinal anesthesia

Relief from the pain of uterine contractions and birth (vaginal and ce- sarean) can be achieved by injecting a suitable local anesthetic agent (e.g., bupivacaine, ropivacaine), an opioid analgesic (e.g., fentanyl, suf- entanil), or both into the epidural (peridural) space. Injection is made between the fourth and fifth lumbar vertebrae for a lumbar epidural block

In spinal anesthesia (block), an anesthetic solution containing a local anesthetic alone or in combination with an opioid agonist analgesic is injected through the third, fourth, or fifth lumbar interspace into the subarachnoid space

Question 6

Epidural

Answer 6

Baseline VS, bolus of IV fluid 500-1000ml
-most common S/E maternal hypotension
 Test dose given
 Much larger dose of anesthetic used for epidural vs.
spinal
 Catheter placed and left in place until after delivery
 Medication may be administered intermittently or
continuously

you can give multiple doses of medication

Question 7

Spinal

Answer 7

Same procedure as for epidural- only one time dose
injection
 Smaller dose of medication used
 May be used for C/S in place of epidura

you can only give one dose

Question 8

Assessment for anesthetics

Answer 8

Urinary output- Foley catheter may be placed
 VS- especially respirations and blood pressure
 Sensation and movement of extremities
 Opioid medications may be administered through
the epidural or spinal for pain relief especially after a
C/S (pain relief up to 24 hours)

monitor for hypotension

Question 9

What is general anesthesia used for?

Answer 9

Used for emergency delivery
 If spinal or epidural are ineffective
 Crosses placenta and causes respiratory depression
in neonate

Question 10

Which of the following adverse effects should be monitored when administering Epidural?

A. Nausea
B. Vomiting
C. Hypotension
D. Hemolytic

Answer 10

C. Hypotension