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Mother Baby > WEEK 7 > Flashcards

WEEK 7 Flashcards

Labor ATI Pain Management ATI

1
Q

presentation of fetus in labor

A

refers to the fetal part entering the pelvis of the pregnant client during labor

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2
Q

what happens during sterile digital examination of

A

the presenting part is palpated, assessing the location of fontanels and other palpable landmarks. Suture lines of the fetal skull will be palpable when the fetus is in a cephalic presentation

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3
Q

suture lines

A

Areas of dense connective tissue between fetal skull bones.

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4
Q

what is the fetal presentation during an uncomplicated labor

A

cephalic presentation

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5
Q

cephalic presentation

A

Fetal head is the part that presents down toward the birth canal.

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6
Q

Less common presentations during labor

A

breech
shoulder
compound

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7
Q

breech

A

The fetal buttocks, feet, or knees present in the maternal pelvis first.

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8
Q

shoulder presentation

A

The fetal shoulder is the lowermost part of the fetus during labor.

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9
Q

compound presentation

A

common, hand over face and you would feel fingers when you do an exam

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10
Q

descriptions of presentation

A

right occiput anterior (ROA), left occiput anterior (LOA), right occiput posterior (ROP), and left occiput posterior

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11
Q

fetal lie

A

position of the fetal long axis (fetal spin) related to the maternal spine

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12
Q

what is the most common fetal attitude

A

head down, chin to chest: good because it puts the crown of the head coming out (it can sustain the pressure)

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13
Q

primiparous clients and maternal structure

A

(client who is experiencing a first pregnancy lasting to at least 20 weeks of gestation)

They may have a most taut pelvic passage that may be more taut, which can be hard for baby to rotate through the birth canal

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14
Q

5 P’s of labor

A

Passenger
Passage
Powers
Position
Psyche

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15
Q

how should contractions be during labor

A

contractions should become more frequent and stronger as they go on

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16
Q

during labor, the client may need to assume multiple positions, such as

A

semi-prone recumbent position, hands and knees, standing, or lunging, to change the shape of their pelvis and assist the fetus to rotate into a favorable position.

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17
Q

how to support client in labor when they are tired from pushing?

A

give good feedback
tug-a-war (the nurse will hold one side the client will pull the nurse towards them and helps push the pelvis)

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18
Q

manifestations signifying labor

A

decrease in pressure on diaphragm (lightening)
increase in vaginal discharge
mucous plug formed during preg may be expelled due to cervical softening
burst of energy (sometimes referred to as nesting)

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19
Q

what might mucous plug drainage look like

A

tinged with a small amount of blood and is referred to as bloody snow

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20
Q

why do irregular uterine contractions manifest during early labor

A

cervix is ripening

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21
Q

During labor and birth, the uterus

A

contracts to expel the fetus

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22
Q

what part of the uterus is responsible for producing labor contractions

A

myometrium

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23
Q

true labor contractions

A

May start in the lower back and lower abdomen and cause pressure in pelvis

May feel like intense menstrual cramps

Get closer together and stronger as time passes

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24
Q

false labor contractions (Braxton Hicks)

A

May feel like mild menstrual cramps

Often uncomfortable, but not painful

Typically stop with rest

Don’t affect the client’s ability to walk, talk, or progress with normal activities

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25
Q

cardiovascular and hematologic system during labor and delivery

A

increase blood volume, CO, SV, HR that resolves between contractions

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26
Q

what cell is increased (expected) during pregnancy

A

lymphocyte values (WBC) as part of the immune system’s response to the physiological stress of pregnancy and labor

so this may hinder identifying infections so other methods besides testing blood will need to be used

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27
Q

GI system during labor (expected)

A

pain can contribute to delayed gastric emptying and increase N/V

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28
Q

what can a delay in gastric emptying lead to

A

increased risk of aspiration

Because of this increased risk, clients will often follow a clear-liquid diet during labor and birth that includes ice chips, tea or coffee, hard candy, popsicles, clear broth, fruit juice, flavored gelatin, and carbonated beverages upon provider recommendations

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29
Q

when might clients experience nausea during labor

A

RAPID cervical dilation or RAPID fetal descent

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30
Q

Renal system during labor

A

mild incontinence as the fetus places pressure on bladder

proteinuria (HTN clients OR normal BP clients)

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31
Q

why would clients during labor with normal BP have proteinuria?

A

increase CO and glomerular permeability, labor stress, and decreased renal tubular protein reabsorption

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32
Q

Endocrine system during labor

A

cortisol levels SURGE
progesterone is present (relax uterus)
increase in estrogen to progesterone ratio
maternal hypothalamus produces oxytocin

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33
Q

Reproductive system during labor

A

uterus will stretch
dilation and effacement of cervix
contractions lead to fetal descent

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34
Q

what is the BEST position for fetus during labor

A

anything ending with OA

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35
Q

what happens during labor process to fetus

A

adapts
changes positions
subject to compression (cone head: HR goes down)

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36
Q

how can the fetus become transiently hypoxic during labor

A

oxygen-rich blood flow is shunted away from placenta into maternal circulation during each contraction

but Blood flow then returns to the uterus during the relaxation period between contractions, allowing for oxygen delivery to the fetus.

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37
Q

can a normal healthy fetus tolerate transient hypoxia

A

yes

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38
Q

how would a fetus respond to stressors like hypoxia or infection?

A

passing meconium into amniotic fluid

greenish discharge of AF from mom

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39
Q

when should babies pass meconium

A

AFTER BIRTH shouldn’t be in utero,
if it is, there may be an issue

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40
Q

what can happen when there is meconium in amniotic fluid

A

increase risk for fetal aspiration
increase risk for infection

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41
Q

when mom gets increase CO and increase O2 consumption, where does it go?

A

placenta which is good

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42
Q

cervical dilation

A

OPENING of cervix (0-10 cm)

closed: can’t get a finger through
open: can touch baby

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43
Q

cervical effacement

A

THINNING of the cervix (%)

thinner means closer to having a baby (high % because it is more open and spreading)

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44
Q

how to shorten the first stage or labor

A

incorporate walking and standing into the plan of care

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45
Q

birth settings

A

health care facilities
home
birthing centers

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46
Q

Clients will often report to health care facilities with manifestations of labor, including

A

frequent contractions
fluid leakage
vaginal bleeding or blooding show

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47
Q

what to do with client presenting with manifestations of labor

A

vital signs (for hemorrhage, preeclampsia, temp)

ask how strong, frequent, duration of contractions if they are presenting with them

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48
Q

Assessment: History and Physical

A

review prenatal history
med/surg history
previous lab results
preform physical assessment

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49
Q

Assessment: Uterine Contractions

A

manual palpation (not great, subjective)
TOCO
IUPC

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50
Q

uterine contractions: manual palpation

A

not great, subjective
but can tell you the difference between contracting or just having uterine hyperstimulation

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51
Q

uterine contractions: tocodynamometer

A

TOCO
external sensor on fundus and secure with stretchy belt
it does NOT measure contraction strength accurately

when done accurately, records contraction frequency and duration and allows the nurse to compare uterine activity with concurrent FHR patterns

measures DURATION AND FREQ BUT NOT STRENGTH

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52
Q

uterine contractions: intrauterine pressure catheter (IUPC)

A

Inserted vaginally into the uterus (only done if TOCO is not recording right)

the amniotic membranes MUST be ruptured to do this

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53
Q

what clients usually have more unsatisfactory contraction tracing

A

obese

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54
Q

what has to happen for IUPC to be in place

A

amniotic membranes have the be ruptured

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55
Q

what can happen if the uterus is contracted for a long time

A

uterine rupture

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56
Q

contraction frequency

A

assess the number of contractions within a 10 minute window

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57
Q

why is a rest period between contractions essential?

A

during contractions, the blood flood in shunted to baby, so hypoxia occurs, but a break would allow baby to get some blood flow to prepare for next contraction

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58
Q

expected uterine contractions

A

five or fewer contractions in a 10-minute period, averaged over 30 mins

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59
Q

tachysystole uterine contractions

A

More than five contractions in a 10-minute period, averaged over 30 minutes

can lead to SEVERE fetal hypoxia

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60
Q

define FREQ of contactions

A

beginning of one to the beginning of the next

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61
Q

dilation exam

A

using sterile glove and lube, nurse puts two fingers into the vaginal canal and locates the cervical os

If only one finger can be inserted into the cervical os, the dilation is approximately 1 centimeter. When the cervix is 10 centimeters dilated, the fetal presenting part will be palpable in front of the cervix so that the cervix is no longer palpable

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62
Q

The client giving birth has entered the second stage of labor once they are

A

10 centimeters dilated

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63
Q

fetal station

A

the fetal position within the maternal pelvis related to the maternal ischial spines, bony prominences within the pelvis.

  • means high up (further away from vag os)
    0 neutral
    + means about to PLUS another soul into the world, so close to delivery
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64
Q

5/80/-1 (define this)

A

5 cm dilated
80% effaced
-1 fetal station (1 cm ABOVE ischial spines of mom PELVIS)

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65
Q

what may PROVIDERS do if in active labor and membranes haven’t ruptured?

A

amniotomy (Artificial rupture of the amniotic membranes)

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66
Q

what is done upon rupture of membranes?

A

amniotic fluid is assessed for…

color
odor
consistency
amount

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67
Q

amniotic fluid is expected to be

A

odorless or have a slight musty odor, have a thin watery consistency, and be clear or straw-colored

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68
Q

vernix

A

cheese-like protective substance on fetal skin

think from clinical vaginal birth

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69
Q

what to assess after membranes are ruptured

A

assess client temp IMMEDIATELY and every 2 hrs til birth because the amniotic sac is protection against infection and it has ruptured

temp of mom
fetal tachycardia
uterine tenderness with palpation
foul-smelling vaginal discharge
elevated maternal HR and RR

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70
Q

who usually tells us something is wrong during labor

A

baby

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71
Q

nitrazine paper

A

test pH of amniotic fluid

pH between 7.1-7.3

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72
Q

important prenatal labs

A

blood type and Rh factor
HIV
hep B
CBC
rubella
STI screenings

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73
Q

Group B strep testing

A

recommended for all preg clients between 36 07-37 6/7

vaginal/rectal swab
if it is + treat with antibiotics
it is not an STD, it does not affect mom only affects baby

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74
Q

nonpharmacological interventions for pain during labor

A

massage
position changes
submersion into water or birthing tubs (think London OB and the jets tub)

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75
Q

nutrition during labor

A

clear liquid diet
IV fluids
urine output monitored to assess hydration status

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76
Q

positioning during labor: what position to avoid

A

avoid supine position due to the risk of supine hypotension and potential FHR decelerations

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77
Q

Leopold Maneuvers

A

should be preformed prior to FHR assessment

steps:

palpate fundus
palpate each side of abd to determine fetal spine
palpate pubis bone for fetal presentation
palpate abd above pubic bone to determine fetal presentation IN THE MATERNAL PELVIS

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78
Q

intermittent auscultation

A

for clients with low risk for labor complications
EXTERNAL auscultation during labor (not continuous so not on all the time, done in intervals)
FHR with handheld Doppler every 15-30 mins

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79
Q

electronic fetal monitoring

A

clients who are at higher risk
continuous

80
Q

what could happen if EFM is placed wrong

A

could get mom HR instead of FHR and lead to unnecessary interventions

81
Q

continuous electronic fetal monitoring types

A

have external Doppler on moms’ belly
OR internal fetal scalp electrode (FSE)

82
Q

fetal scalp electrode (FSE)

A

small spiral wire or clip that is placed into fetal presenting part (head or butt)

twisted just under fetal skin (epidermis) and is accurate

ruptured membranes are required for this

83
Q

where is tocotransducer placed

A

external on moms UPPER ABDOMEN OVER THE UTERINE FUNDUS

84
Q

baseline FHR

A

110-160
average over 10 min window and rounded to nearest 5-increment beat

85
Q

tocotransducer and ultrasound transducer

A

TOCO trasducer: uterine tone during contractions

ultrasound transducer: FHR

86
Q

where to put ultrasound transducer

A

between the umbilicus and symphysis pubis

if breech, put at level or above the umbilicus

87
Q

internal fetal monitoring requirements

A

ruptured membranes
cervix is dilated at least 2 cm

88
Q

difference of IUPC and FSE

A

IUPC: contractions (strength, duration, freq)

FSE: fetal HR assessment

89
Q

tracing papers

A

top is FHR
bottom is uterine activity/contractions

each light vertical line is 10 seconds, each dark vertical line is 1 min

90
Q

fetal HR tracing papers

A

each light vertical line: 10 sec
each dark vertical line: 1 min
each horizontal line: 10 increment beats (110,120,130, etc)

91
Q

uterine contractions/activity tracing papers

A

each light vertical line: 10 sec
each dark vertical line: 1 min
each horizontal line: amount of pressure the uterus is exerting (mmHg)

92
Q

baseline FHR variability: define

A

observed as fluctuations in FHR from the baseline rate during a 10-min period.

93
Q

how is variability described

A

absent
minimal
moderate
marked

94
Q

minimal varability

A

less than 5/min

95
Q

moderate variability

A

6-25/min

96
Q

marked variability

A

more than 25/min

97
Q

Variability, like the baseline rate, can be influenced by the central nervous system and other physiological changes, such as

A

baroreceptor activation

98
Q

if the fetus is experiencing minimal or absent variability…

A

it does not always mean a complication but fetal hypoxia cannot be ruled out

99
Q

accelerations

A

abrupt increases of at least 15/min above baseline lasting at least 15 seconds

15x15

100
Q

are accelerations common

A

Accelerations are common findings in the FHR pattern and are not required to determine fetal well-being

101
Q

decelerations

A

variable
early
late
prolonged

102
Q

VEAL : CHOP

A

Variable
Early
Accelerations
Late

Cord compression
Head compression
Oxygenated
Placental insufficiency

103
Q

VARIABLE DECELERATIONS

A

abrupt decrease in FHR as shape of V, U, or W

decrease of at least 15/min and last at least 15 sec

104
Q

Variable decelerations associated with what

A

VEAL CHOP

Cord compression

105
Q

EARLY DECELERATIONS

A

gradual decreases of FHR that mirror contractions

reaches lowest point 30 or more seconds after it begins to decrease

106
Q

Early decelerations associated with what

A

VEAL CHOP

Head compression

107
Q

Early decels don’t correlate with what

A

decreases O2

since uterine pressure on the fetal head is normal

early decels do not warrant nursing interventions

108
Q

LATE DECELERATIONS

A

the FHR gradually decreases after the peak of the contraction, taking at least 30 seconds to reach the lowest point.

109
Q

Late decelerations associated with what

A

VEAL CHOP

Placental insufficiency

110
Q

Late decels on a tracing

A

decrease AFTER peak on contraction!!!! look at UA paper too

flat at baseline then drop down

111
Q

Early decels on a tracing

A

MIRRORS the peak of contractions!!! important in reading tracings

the nadir and peak of contractions occur simultaneously

will look even and steady and not a lot of variability

112
Q

Variable decels on a tracing

A

very low V or U or W shape

113
Q

prolonged decelerations

A

non-reassuring FHR pattern characterized by a decrease in FHR from the baseline of at least 15/min for longer than 2 min but less than 10 min

longer than 10 mins: change in baseline FHR

114
Q

SINUSOIDAL PATTERN

A

smooth, wave-like pattern lasting longer than 20 MINUTES

115
Q

what would a true sinusoidal pattern result in?

A

it is an emergency

intrauterine resuscitation MUST be initiated

116
Q

intrauterine resuscitation

A

Interventions that aim to increase oxygenated blood flow to the fetus in times of distress.

117
Q

fetal bradycardia

A

less than 110/min for at least 10 mins or longer

immediate intrauterine resuscitation!!

associated with: hypoxia, umbilical cord compression, umbilical cord prolapse, placental abruption, or uterine rupture

118
Q

fetal tachycardia

A

greater than 160/min for at least 10 mins or longer

intrauterine resuscitation efforts!!!

associated with: fetal tachycardia include cardiac anomalies, prolonged fetal activity, and severe prematurity, maternal fever, dehydration, fetal distress, and chronic hypoxia

119
Q

For the client experiencing an expected labor process without pharmacologic interventions such as oxytocin to stimulate uterine contractions, the nurse must evaluate

A

the FHR pattern at least every 15 to 30 minutes during the first stage of labor, assessing the fetal monitor strip for unexpected findings associated with categories II and III, and incorporating interventions as necessary to ensure safety

120
Q

what to do if fetus is having variable decelerations

A

change the maternal position to LATERAL POSITION to relieve cord compression and promote blood flow to uterus

121
Q

when should intrauterine resuscitation measures be initiated?

A

late, variable, or prolonged decelerations

122
Q

what measures are used to do intrauterine resuscitation? (5 things)

A

IV fluids
applicated of O2 (nonrebreather) (10 L)
discontinuing uterotonic meds (OXYTOCIN)
facilitating emergency birth IF pattern does not resolve (operative vaginal birth or C section)
position changes (right/left lateral/knee-chest position)

123
Q

Intrauterine Resuscitation Measures: Increase Fetal Oxygenation

A

Maternal repositioning

Increase IV fluids

Administer supplemental oxygen for compromised maternal oxygenation status

Discontinue uterotonics

Emergent birth if indicated

124
Q

what to do if client is experiencing uterine activity tachysystole?

A

stop uterotonics (like oxytocin)

if that does not work, administer a tocolytic to promote uterine relaxation

125
Q

Tocolytic medications: what do they do?

A

target the smooth muscle of the uterine myometrium causing contractions to weaken, slow, or stop

126
Q

common tocolytic medications

A

Terbutaline
Nifedipine

127
Q

Terbutaline

A

beta-adrenergic

ADVERSE EFFECTS:

Common: Shakiness of legs, arms, hands, and feet, dizziness, lightheadedness, flushing of face and neck, headache, sweating

Rare: Burning, crawling, numbness, itching, tingling, increased muscle tone or stiffness

128
Q

Nifedipine

A

calcium channel blocker

ADVERSE EFFECTS:

Headache, dizziness, nausea, hypotension, fainting, edema

DO NOT take if you have hypotension

129
Q

From class notes: what to do if someone is having late or sinsounal decels/pattern?

A

Intrauterine resuscitation

Turn patient
Give IV blous (increase mom BP)
O2 (nonrebreather 10 L)
STOP oxytocin/Pitocin (uterotonic meds)
Terbutaline (which can cause increase in mom and babies HR)

130
Q

what medication to give if mom’s BP is going down (and what is a common expected outcome)

A

Ephedrine

expected outcomes: fetal tachycardia (do not have to report this outcome or do interventions, it is expected!)

131
Q

what are some reasons for a minimal variability in fetal HR and patterns?

A

minimal (<5/min)

sick, sleep, sedated

132
Q

are accelerations on FHR tracing good or bad?

A

GOOD! that means the baby is oxygenated

VEAL CHOP

133
Q

what are some pain medications to know?

A

Morphine
Stadol
Fentanyl
Nubain

134
Q

what position to decrease pressure on the maternal vena cava from uterus?

A

later or knee to chest

135
Q

when would you NOT want to do FSE?

A

maternal infection of HIV/Hep B

it opens the skin so the maternal infection could get into the baby and make a systemic infection

136
Q

amnioinfusion

A

a sterile solution such as sterile saline or lactated Ringer’s is infused into the uterine cavity through an IUPC to restore amniotic fluid volume, with the goal of decreasing pressure on the umbilical cord

137
Q

when would you do an amnioinfusion?

A

VARIABLE decelerations

to get baby off that cord

decrease pressure on the umbilical cord

138
Q

normal findings with fetal HR

A

EARLY decelerations are normal:
in relation to a contraction
mirror image of the contraction
peak of contraction and very bottom of decel will line up on tracing
because of head compression

Moderate VARABILITY: 6-25/min around baseline so moderate
this indicates nervous system

139
Q

normal fetal heart rate

A

110/160 bpm

140
Q

abnormal findings in fetal heart rate patterns

A

bradycardia: <110/min sustained at least 10 mins
this happens: prolonged cord compression, cord prolapse, anesthetic medications, fetal heart issues in general
can lead to fetal hypoxia
things to do: intrauterine resuscitation

tachycardia: >160/min sustained at least 10 mins
this happens: big one is MATERNAL FEVER or infection, maternal hyperthyroidism, cocaine use (stimulant), fetal hypoxia
things to do: intrauterine resuscitation

141
Q

fetal tachycardia accompanied by decreased variability is indicated of what?

A

fetal distress
we want baby earthside at the point

142
Q

late variability tracing

A

contraction goes up and down but the bottom of the deceleration goes AFTER the peak of contraction, aka LATER than peak of contraction: late deceleration

VEAL CHOP: placental insufficiency

decrease blood flow to baby can lead to fetal hypoxia which is causing the decels in the HR

143
Q

variable decelerations tracing

A

look like a V (sharp, dramatic drop & quick to come back up)
VEAL CHOP: cord compression
leads to increase fetal BP=decrease fetal HR
knee-chest position
AMNIOINFUSION (oligohydramnios)

144
Q

What does moderate variability in the fetal heart rate indicate?

A

A healthy fetal nervous system

145
Q

two types of pain during labor

A

visceral pain (organ or nerve pain)
somatic pain (muscles, joints, bones)

146
Q

labor pain: visceral pain

A

uterine contractions
cervical dilation

147
Q

labor pain: somatic pain

A

pelvis muscle and perineal tissue (from baby putting pressure on it)

148
Q

pain scale for clients in labor

A

0-10

149
Q

clients coping well with labor pain

A

moaning
rhythmic breathing
relaxation between contractions

150
Q

clients who are not coping well with labor pain

A

verbalize it to nurse maybe
trouble relaxing
increasingly agitated
cry
sweat

151
Q

how to help client who is not coping well with pain (nonpharmacological interventions)

A

adjust lighting, how many visitors are there, room temperature

support people, massage, aid in changes in position, heat/cold therapy
sitting on birthing ball, warm shower

152
Q

what is the temp in room for when baby is about to be born

A

72-74 because it needs to be warm

153
Q

how can anxiety increase pain in labor

A

release of catecholamines

154
Q

labor pain nonpharmacological pain management: relaxation and breathing exercises

A

lower maternal BP and RR
YOGA
Bradley method and Lamaze method

helps mom control her anxiety, confidence up, and for her to feel more in control during labor

155
Q

labor pain nonpharmacological pain management: positions

A

upright (sitting, squatting, standing)

156
Q

what positions should the client avoid during labor as it can increase pain?

A

supine (like lithotomy position)

157
Q

labor pain nonpharmacological interventions: touch and massage

A

counterpressure
massage
accupunture

158
Q

how can accupuncture help with pain in labor?

A

removes lactic acid which improves pain

159
Q

labor pain nonpharmacological pain management: heat and cold

A

back, abdomen, sacrum, perineal areas

160
Q

labor pain nonpharmacological pain management: water thearpy

A

immerse in bathtub or pool or standing in water (not too hot, under 100.4)

calm muscle tension

clients between 37-42 weeks

161
Q

when should opioids NOT be administered to labor patients

A

within 1 HOUR of birth

because it can cause negative impacts on the newborn’s respiratory system

162
Q

fetal adverse effects on maternal opioid use during labor

A

decrease in APGAR score
Increase in incidence of respiratory depression
Decrease in muscle tone
Difficulty sucking for eating
Changes in neurobehavior

163
Q

what are two opioid agonists

A

fentanyl
morphine

164
Q

what is preferable choice with opioid agonists?

A

fentanyl

it is fast acting and does not last long, it has minimal fetal effects

165
Q

what should be closely monitored when given opioid angonists?

A

fetal heart rate (can cause a decrease in variability)

166
Q

maternal side effects of opioid agonists?

A

maternal side effects:

N/V
possible respiratory depression

167
Q

what is usually given with opioid?

A

antiemetic to prevent N/V

like ondansetron

also have an opioid antagonist available always

168
Q

what to do after admin of opioid to mom?

A

follow-up vitals, pain, coping
safety (call light in reach) because opioids can cause hypotension, dizziness, and drowsiness

169
Q

what to monitor after giving antiemetic?

A

cause constipation, so monitor for N/V, increase fluid, etc

170
Q

what is another opioid agonist besides fentanyl and morphine?

A

Remifentanil

ultra-short acting
PCA pump

MONITOR CLOSELY for respiratory depression and potential need for oxygen supplementation

171
Q

what is an opioid agonist-antagonist that can be used during labor?

A

Nalbuphine

172
Q

why would you use a mixture like an opioid agonist-antagonist?

A

like Nalbuphine, less chance of risk for respiratory depression

173
Q

when should opioid agonist-antagonists NOT be admined?

A

if client has or is receiving tx for opioid use disorder

174
Q

what is common and okay to use opioid antagonist?

A

Naloxone

used for respiratory depression

175
Q

local anesthestics for perineal repair (tearing)

A

lidocaine and bupivacaine

no newborn side effects because of where it is located

176
Q

episiotomy

A

surg incision to kind of tear perineum to ease infant out

177
Q

what to do with perineal infiltration?

A

often correlated with an episiotomy

178
Q

pudendal block medication

A

during pushing or when tear is being stitched back up

179
Q

spinal block

A

single injection of an opioid, local anesthetic, or combination of the two into the subarachnoid space

180
Q

what are opioids that can be used in a spinal block

A

fentanyl
morphine

181
Q

what are local anesthestics that can be used with a spinal block?

A

lidocaine
bupivacaine

182
Q

epidural analgesia: what is it?

A

provides full or partial removal of pain below T8 and T10 on the spine

gold standard in relieving pain

small cath placed between spinous processes into the lumbar epidural space

183
Q

Medications that can be used with an epidural analgesic?

A

local anesthesia (bupivacaine) with OR without an opioid (fentanyl)

PCA pump as client feels pain (intermittently) or can be continous

184
Q

contraindications to epidural

A

Coagulopathy
Spine that is not stable or limitations in spinal positioning
Spinal anomalies (spina bifida, scoliosis)
Anomalies with the central nervous system (multiple sclerosis, syringomyelia)
Cardiac anomalies (aortic stenosis)
Sepsis or infection around the site where the catheter will be placed
Allergy to opioids
Hypovolemia that has not been addressed
Increase in intracranial pressure

185
Q

coagulopathy

A

less than 100,000 platelets

186
Q

complications with epidural

A

infections
epidural hematoma
movement of catheter
severe headache

187
Q

what to gather before epidural placement (5 things!)

A

vitals
O2 mask
Naloxone
crash cart
Ephedrine

188
Q

why do you give Ephedrine to mom?

A

to increase BP when hypotension occurs form anesthesia (epidural)

189
Q

what will a mom usually get before getting an epidural?

A

IV bolus to hopefully prevent maternal hypotension

lateral position and nurse should stand in front to provide support and encourage relaxation

190
Q

Conditions That Require Removal of an Epidural Catheter by an Anesthesia Provider

A

Unexpected clotting time
Pain during removal
Resistance during removal
Suspected infection

191
Q

when is general anesthesia used for labor pain?

A

emergencies only or when spinal/epidural cannot be administered

192
Q

Complications From General Anesthesia

A

Allergic reaction to anesthetics
Sore throat
Damage to throat, teeth, or vocal cords
Infection in the lungs
Awareness during surgery
Stroke
Myocardial infarction
Postpartum hemorrhage

193
Q

when general anesthesia is used…?

A

client will be preoxygenated and given either propofol
OR ketamine + succinylcholine

194
Q

One of the reasons general anesthesia is not used often during birth is due to the

A

decrease in uterine tone, leading to a PPH

195
Q

what to monitor if mom was given general anesthesia?

A

uterine tone (fundus)
assess for bleeding

196
Q

how to use nitrous oxide for pain management?

A

inhale at the START of a contraction

197
Q

what to remind patient about with nitrous oxide?

A

it will not relieve all pain

Mother Baby (9 decks)

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