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OB > Week 1 Pain Management during labor > Flashcards

Week 1 Pain Management during labor Flashcards

1
Q

What are the 5 main contraindications of a epidural/block?

A
  • Anticoagulant therapy or bleeding diathesis
  • Hemorrhage or shock
  • Infection at insertion site
  • Tumor
  • Increased ICP
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2
Q

What are the characteristics of Butorphanol?

A
  • Is both an opiate agonist and antagonist
  • May cause opioid withdraw
  • Resp. depressant
  • May be given to relieve pruitus associated with epidural
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3
Q

What are vasopressors used for during labor?

A

to correct hypotension r/t epidural or subarachnoid block

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4
Q

How does pain affect the pulmonary system?

A

increased O2 demand leads to hyperventilation

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5
Q

What does a Subarachnoid (spinal) Block alleviate?

A

pain from

  • uterus
  • Perineum
  • Lower back
  • Vagina
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6
Q

Where can T6 sensation be checked?

A

Xiphoid

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7
Q

Cortisol causes a _____ system responce

A

Sympathetic NS

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8
Q

What is first stage breathing?

A

Breathing that is done during contractions. rapid respiration

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9
Q

How is a epidural catheter test dose done?

A

A short acting anesthetic is administered into the epidural catheter. Correct placement is determined by area od numbness as well as absence of adverse effects

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10
Q

How is proper epidural placement confirmed?

A

Through an epidural catheter test dose

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11
Q

What are the characteristics of pushing and pulling pain on pelvic structures?

A
  • Visceral

- Transfers to back and legs

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12
Q

What indicates a positive intravascular test dose during a epidural catheter test dose

A

20 bpm increase of heart rate within 45 seconds of administration

  • Circumoral numbness
  • Tinnitus
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13
Q

What labs are done prior to a Block?

A

-Platlets
-PT
-INR
All R/T clotting

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14
Q

When sound the initial dose be given for the block?

A

Between contractions

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15
Q

where does pain from Distention of the vagina and perineum enter the spinal cord?

A

s2-s4

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16
Q

Platelets must be below ___ before the catheter is removed

A

100,000

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17
Q

Where can T10 sensation be checked?

A

Umbilicus

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18
Q

What is the dose and frequency of Butorphanol?

A

1-2mg every 3-4 hours (range of 0.5-2mg IV)

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19
Q

What five interventions are to be done prior to a block?

FVLPI

A
  • Nonglucose fluid bolus of 500-1000cc
  • Baseline vitals of mom and baby
  • Labs
  • Positioning
  • Keep Pt informed of sensations they may feel
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20
Q

What are the adverse effects of a Subarachnoid (Spinal) Block?

A
  • Hypotension
  • Bladder distention
  • Post-Dural punture HA
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21
Q

What is a Intrathecal opioid analgesics

A
  • Medications injected into the subaracnoid space
  • Rapid onset
  • can be used in conjunction with an epidural
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22
Q

When is an epidural given?

A

After labor is established

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23
Q

During an epitural, VS and Neuro status should be checked every_____

A

hour

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24
Q

What is the dose and frequency of Nalbuphine?

A

10mg every 3 hours IV may be given as a PCA

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25
Q

What are the three regional pain management types?

A
  • Epidural
  • Intrathecal opioid analgesics
  • Subarachnoid (spinal) Block
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26
Q

What are the 5 assessments after injections through epidurals?

A
  • BP
  • VS/Neuro
  • Fetal/Contraction
  • Bladder distention
  • Activity (bedrest unless only opioids)
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27
Q

When should pain meds be given during the contraction cycle?

A

Second half of the contraction

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28
Q

What is the dose and duration of Chloroprocaine?

A

-6 to 10ml

30-45minutes

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29
Q

What are two common anesthetic solutions used in a block?

A
  • Chloroprocaine

- Bupivacaine

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30
Q

What are the 3 main pharmocologic meds given to women during labor?

A
  • Fentanyl
  • Butorphanol
  • Nalbuphine
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31
Q

Where can T12 sensation be checked?

A

Pubis

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32
Q

What are the advantages of a Spinal (intrathecal) injection

A
  • Rapid onset
  • No sedation
  • No motor block
  • No sympathetic block (no hypotension effects)
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33
Q

What are the psychological disadvantages of pharm. pain relief in labor?

A
  • Loss of “natural” childbirth
  • Pt not feeling in control of her body
  • Husbands may feel a lack of participation and may feel left out of the labor and delivery experience
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34
Q

What is the normal dose of Phenylephrine during labor?

A

50-100 mcg

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35
Q

If maternal hypotension occurs, what should be done?

A
  • Position change
  • Bolus of IVF
  • Vasopressors: Ephedrine 5-10 mg) does not affect blood flow to the uterus) or phenylephrine
  • Oxygen via face mask (8-10L/min)
36
Q

What is the other name for Nalbuphine?

A

Nubain

37
Q

What spinal locations is perineal pain transmitted?

A

s2-s4

38
Q

What are the con’s of an epidural?

A
  • hypotension
  • Bladder distention
  • prolonged second stage
39
Q

How is Nitrous oxide administered?

A
  • Patient self administers

- 50-50 blend with oxygen

40
Q

How does pain effect the GI system?

A

Delayed emptying

41
Q

How can Opioid induced pruritis be treated?

A
  • Opioid agonist-antagonist (Nalbuphrine)

- 5-HT3 receptor antagonist (ondansetron)

42
Q

What two vital signs need to be monitored while a patient has a epidural?

A

O2 sat and BP

43
Q

What are the four main sources of pain during pregnancy?

A
  1. Tissue ischemia
  2. Cervical dilation
  3. Pressure and pulling on pelvis
  4. Distention of the vagina and perineum
44
Q

Describe the gate control theory

A

Pain is transmitted through small fibers. If you activate the large fibers near them, the small fibers will not be able to transmit

45
Q

What are the 4 main non-pharmacologic pain control methods?

A
  • relaxation
  • cutaneous stimulation
  • Hydrotherapy
  • Mental stimulation
46
Q

How can N/V be treated in a pregnant/laboring mother?

A
  • Metochlpramide
  • Ondansetrol
  • Scopolamine
47
Q

How does an epidural cause maternal hypotension?

When does this occur?

A
  • Sympathetic NS fibers are blocked resulting in vasoconstriction
  • Usually occurs immediately but can be delayed up to 20 minutes following injection
48
Q

What drug is given if respiratory depression occurs?

A

Narcan

49
Q

Full oral intake may be resumed after block is below ____ level

A

T10

50
Q

What causes tissue ischemia during labor and what are the detrimental effects?

A
  • Caused by decreased blood flow to uterus during contractions
  • Can cause tissue hypoxia and fetal anaerobic metabolism
51
Q

Where does cervical dilation pain travel?

A

through the hypogastric plexis entering the SC at T10-L1

52
Q

How is epidural placement verified prior to administration of meds?

A

Aspiration. Absence of blood or CSF is a positive result

53
Q

What narcotic can be given to pregnant women in a PCA?

A

Fentanyl

54
Q

BP should be checked every ___ minutes for ____ minutes after each bolus dose

A

5

15-30minutes

55
Q

Where is a Subarachnoid (spinal) Block placed?

A

L3 to L5

56
Q

What spinal locations is uterine contraction pain transmitted?

A

T10-L1

57
Q

What sensations may a PT feel during the procedure of getting a block>

A
  • Burning/stinging on skin
  • Pressure with insertion
  • Crazy bone sensation in legs as catheter is advanced
58
Q

Where is the common location of an epidural?

A

Between L3 and L4

59
Q

What are the characteristics of fentanyl?

A
  • Quick onset
  • Short duration
  • Less associated N/V
  • Low risk of resp. depression
60
Q

What are the CON’s of a Subarachnoid (spinal) Block?

A

May cause HA

May cause maternal hypotension

61
Q

What are the two common vasopressors used during labor?

A

Phenylephrine and ephedrin

62
Q

What is the other name for Butorphanol?

A

Stadol

63
Q

What are some potential adverse effects of a test dose?

A

heart palpitations, tachycardia, tachydysrhythmias, hypotension, motor blockade, and, in rare cases, seizures

64
Q

How does pain effect the CV system?

A
  • increased BP
  • Increased CO
  • Increased vascular resistance
65
Q

What are the four Epidural opioids?

A
  • Fentanyl
  • Sufentanil
  • Ropivacaine
  • Morphine (Duramorph or Astramorph)
66
Q

What are the disadvantages of Spinal (intrathecal) injections

A
  • Short acting

- Inadequate pain control

67
Q

When are Spinal (intrathecal) injections considered?

A

-PT’s who require pain relief but did not have time for an epidural

68
Q

Give some examples of using gate control to relieve pain

A

Massage, thermal stimulation, hydrotherapy, focal point, breathing, environmental control

69
Q

What is the normal dose of ephedrin during labor?

A

5-10mg

70
Q

What are the signs of accidental durai puncture in a epidural?

A
  • Respiratory depression
  • Circulatory collapse with hypotension
  • Decreased uterine blood flow
71
Q

How should BP be monitored after epidural doses?

When should you contact the provider?

A
  • Monitor BP every 3-5 mins for the first 15 min; then q 15 min thereafter
  • Notify Anesthesia provider: systolic BP <100 mm HG or a fall of 20% or more from baseline, pallor, or diaphoresis
  • Assess FHR: Tachycardia >160 bpm for 10 min, brady <110 bpm for 10 min, late decel
72
Q

What relief does an epidural give?

A
  • Pain from contractions
  • Numbs the vagina and perineum
  • No HA because dura mater is not penetrated
73
Q

What are the 6 main complications of an epidural/block?

A
  • Hypotension
  • Durai puncture resulting in total spinal anestheasia
  • Resp. depression
  • Catheter migration
  • Maternal Fever
  • Seizure
74
Q

Respiratory depression is a RR below

A

12 breaths per minute

75
Q

What are the characteristics of Nalbuphine

A
  • Is both an opiate agonist and antagonist
  • May cause opioid withdraw
  • Resp. depressant
  • May be given to relieve pruitus associated with epidural
76
Q

What is second stage breathing?

A

Closed glottis: causes recurrent increases in intrathoracic pressure with resulting fall in cardiac output and maternal BP

Open-glottis: pushing 3-4 times for 6 to 8 seconds likely to be effective in aiding descent and safe. Adjust the pushing process depending on fetal status

77
Q

Where can T8 sensation be checked?

A

Costal

78
Q

What are the benefits of regional pain management during pregnancy?

A
  • The veins are dilated during pregnancy

- Prevents full motor block

79
Q

What is the dose and frequency of Fentanyl?

A

50-100 mcg every hour

80
Q

What indicates a positive subarachnoid placement during a epidural catheter test dose

A

Rapid onset of sensory and motor blockade with or without Hypotension

81
Q

Blocking the bodies reaction vasoconstriction reaction to a hemmorrhage or shock using a epidural or block will cause _____

A

Vasodilation thus causing BP to bottom out and increased bleeding

82
Q

____must be done prior to ambulation

A

Sensory-motor assessment

83
Q

What is maternal fever?

A

A fever of unknown cause that is related to epidurals

84
Q

What is the dose and duration of Bupivacaine? how about for a c-section?

A
  • 6 to 10ml
    1-2 hours
    -0.75% in doses of 15-20ml
85
Q

What are the three main effects of catecholamines on a laboring mother?

A
  1. Reduced blood flow to and from placenta
  2. Increased maternal metabolic rate and O2 demand. Can cause fetal acidosis
  3. Reduced effectiveness of contractions causing slow labor progress
86
Q

What can cause seizures from an epidural?

A
  • Accidnetal injection of meds into venous system. Toxic levels of medicaiton
  • Also, total spinal anesthesia

OB (14 decks)

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