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
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
3
Q
suture lines
A
Areas of dense connective tissue between fetal skull bones.
4
Q
what is the fetal presentation during an uncomplicated labor
A
cephalic presentation
5
Q
cephalic presentation
A
Fetal head is the part that presents down toward the birth canal.
6
Q
Less common presentations during labor
A
breech
shoulder
compound
7
Q
breech
A
The fetal buttocks, feet, or knees present in the maternal pelvis first.
8
Q
shoulder presentation
A
The fetal shoulder is the lowermost part of the fetus during labor.
9
Q
compound presentation
A
common, hand over face and you would feel fingers when you do an exam
10
Q
descriptions of presentation
A
right occiput anterior (ROA), left occiput anterior (LOA), right occiput posterior (ROP), and left occiput posterior
11
Q
fetal lie
A
position of the fetal long axis (fetal spin) related to the maternal spine
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)
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
14
Q
5 P’s of labor
A
Passenger
Passage
Powers
Position
Psyche
15
Q
how should contractions be during labor
A
contractions should become more frequent and stronger as they go on
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.
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)
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)
19
Q
what might mucous plug drainage look like
A
tinged with a small amount of blood and is referred to as bloody snow
20
Q
why do irregular uterine contractions manifest during early labor
A
cervix is ripening
21
Q
During labor and birth, the uterus
A
contracts to expel the fetus
22
Q
what part of the uterus is responsible for producing labor contractions
A
myometrium
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
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
25
cardiovascular and hematologic system during labor and delivery
increase blood volume, CO, SV, HR that resolves between contractions
26
what cell is increased (expected) during pregnancy
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
27
GI system during labor (expected)
pain can contribute to delayed gastric emptying and increase N/V
28
what can a delay in gastric emptying lead to
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
29
when might clients experience nausea during labor
RAPID cervical dilation or RAPID fetal descent
30
Renal system during labor
mild incontinence as the fetus places pressure on bladder
proteinuria (HTN clients OR normal BP clients)
31
why would clients during labor with normal BP have proteinuria?
increase CO and glomerular permeability, labor stress, and decreased renal tubular protein reabsorption
32
Endocrine system during labor
cortisol levels SURGE
progesterone is present (relax uterus)
increase in estrogen to progesterone ratio
maternal hypothalamus produces oxytocin
33
Reproductive system during labor
uterus will stretch
dilation and effacement of cervix
contractions lead to fetal descent
34
what is the BEST position for fetus during labor
anything ending with OA
35
what happens during labor process to fetus
adapts
changes positions
subject to compression (cone head: HR goes down)
36
how can the fetus become transiently hypoxic during labor
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.
37
can a normal healthy fetus tolerate transient hypoxia
yes
38
how would a fetus respond to stressors like hypoxia or infection?
passing meconium into amniotic fluid
greenish discharge of AF from mom
39
when should babies pass meconium
AFTER BIRTH shouldn't be in utero,
if it is, there may be an issue
40
what can happen when there is meconium in amniotic fluid
increase risk for fetal aspiration
increase risk for infection
41
when mom gets increase CO and increase O2 consumption, where does it go?
placenta which is good
42
cervical dilation
OPENING of cervix (0-10 cm)
closed: can't get a finger through
open: can touch baby
43
cervical effacement
THINNING of the cervix (%)
thinner means closer to having a baby (high % because it is more open and spreading)
44
how to shorten the first stage or labor
incorporate walking and standing into the plan of care
45
birth settings
health care facilities
home
birthing centers
46
Clients will often report to health care facilities with manifestations of labor, including
frequent contractions
fluid leakage
vaginal bleeding or blooding show
47
what to do with client presenting with manifestations of labor
vital signs (for hemorrhage, preeclampsia, temp)
ask how strong, frequent, duration of contractions if they are presenting with them
48
Assessment: History and Physical
review prenatal history
med/surg history
previous lab results
preform physical assessment
49
Assessment: Uterine Contractions
manual palpation (not great, subjective)
TOCO
IUPC
50
uterine contractions: manual palpation
not great, subjective
but can tell you the difference between contracting or just having uterine hyperstimulation
51
uterine contractions: tocodynamometer
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
52
uterine contractions: intrauterine pressure catheter (IUPC)
Inserted vaginally into the uterus (only done if TOCO is not recording right)
the amniotic membranes MUST be ruptured to do this
53
what clients usually have more unsatisfactory contraction tracing
obese
54
what has to happen for IUPC to be in place
amniotic membranes have the be ruptured
55
what can happen if the uterus is contracted for a long time
uterine rupture
56
contraction frequency
assess the number of contractions within a 10 minute window
57
why is a rest period between contractions essential?
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
58
expected uterine contractions
five or fewer contractions in a 10-minute period, averaged over 30 mins
59
tachysystole uterine contractions
More than five contractions in a 10-minute period, averaged over 30 minutes
can lead to SEVERE fetal hypoxia
60
define FREQ of contactions
beginning of one to the beginning of the next
61
dilation exam
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
62
The client giving birth has entered the second stage of labor once they are
10 centimeters dilated
63
fetal station
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
64
5/80/-1 (define this)
5 cm dilated
80% effaced
-1 fetal station (1 cm ABOVE ischial spines of mom PELVIS)
65
what may PROVIDERS do if in active labor and membranes haven't ruptured?
amniotomy (Artificial rupture of the amniotic membranes)
66
what is done upon rupture of membranes?
amniotic fluid is assessed for...
color
odor
consistency
amount
67
amniotic fluid is expected to be
odorless or have a slight musty odor, have a thin watery consistency, and be clear or straw-colored
68
vernix
cheese-like protective substance on fetal skin
think from clinical vaginal birth
69
what to assess after membranes are ruptured
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
70
who usually tells us something is wrong during labor
baby
71
nitrazine paper
test pH of amniotic fluid
pH between 7.1-7.3
72
important prenatal labs
blood type and Rh factor
HIV
hep B
CBC
rubella
STI screenings
73
Group B strep testing
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
74
nonpharmacological interventions for pain during labor
massage
position changes
submersion into water or birthing tubs (think London OB and the jets tub)
75
nutrition during labor
clear liquid diet
IV fluids
urine output monitored to assess hydration status
76
positioning during labor: what position to avoid
avoid supine position due to the risk of supine hypotension and potential FHR decelerations
77
Leopold Maneuvers
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
78
intermittent auscultation
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
79
electronic fetal monitoring
clients who are at higher risk
continuous
80
what could happen if EFM is placed wrong
could get mom HR instead of FHR and lead to unnecessary interventions
81
continuous electronic fetal monitoring types
have external Doppler on moms' belly
OR internal fetal scalp electrode (FSE)
82
fetal scalp electrode (FSE)
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
where is tocotransducer placed
external on moms UPPER ABDOMEN OVER THE UTERINE FUNDUS
84
baseline FHR
110-160
average over 10 min window and rounded to nearest 5-increment beat
85
tocotransducer and ultrasound transducer
TOCO trasducer: uterine tone during contractions
ultrasound transducer: FHR
86
where to put ultrasound transducer
between the umbilicus and symphysis pubis
if breech, put at level or above the umbilicus
87
internal fetal monitoring requirements
ruptured membranes
cervix is dilated at least 2 cm
88
difference of IUPC and FSE
IUPC: contractions (strength, duration, freq)
FSE: fetal HR assessment
89
tracing papers
top is FHR
bottom is uterine activity/contractions
each light vertical line is 10 seconds, each dark vertical line is 1 min
90
fetal HR tracing papers
each light vertical line: 10 sec
each dark vertical line: 1 min
each horizontal line: 10 increment beats (110,120,130, etc)
91
uterine contractions/activity tracing papers
each light vertical line: 10 sec
each dark vertical line: 1 min
each horizontal line: amount of pressure the uterus is exerting (mmHg)
92
baseline FHR variability: define
observed as fluctuations in FHR from the baseline rate during a 10-min period.
93
how is variability described
absent
minimal
moderate
marked
94
minimal varability
less than 5/min
95
moderate variability
6-25/min
96
marked variability
more than 25/min
97
Variability, like the baseline rate, can be influenced by the central nervous system and other physiological changes, such as
baroreceptor activation
98
if the fetus is experiencing minimal or absent variability...
it does not always mean a complication but fetal hypoxia cannot be ruled out
99
accelerations
abrupt increases of at least 15/min above baseline lasting at least 15 seconds
15x15
100
are accelerations common
Accelerations are common findings in the FHR pattern and are not required to determine fetal well-being
101
decelerations
variable
early
late
prolonged
102
VEAL : CHOP
Variable
Early
Accelerations
Late
Cord compression
Head compression
Oxygenated
Placental insufficiency
103
VARIABLE DECELERATIONS
abrupt decrease in FHR as shape of V, U, or W
decrease of at least 15/min and last at least 15 sec
104
Variable decelerations associated with what
VEAL CHOP
Cord compression
105
EARLY DECELERATIONS
gradual decreases of FHR that mirror contractions
reaches lowest point 30 or more seconds after it begins to decrease
106
Early decelerations associated with what
VEAL CHOP
Head compression
107
Early decels don't correlate with what
decreases O2
since uterine pressure on the fetal head is normal
early decels do not warrant nursing interventions
108
LATE DECELERATIONS
the FHR gradually decreases after the peak of the contraction, taking at least 30 seconds to reach the lowest point.
109
Late decelerations associated with what
VEAL CHOP
Placental insufficiency
110
Late decels on a tracing
decrease AFTER peak on contraction!!!! look at UA paper too
flat at baseline then drop down
111
Early decels on a tracing
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
Variable decels on a tracing
very low V or U or W shape
113
prolonged decelerations
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
SINUSOIDAL PATTERN
smooth, wave-like pattern lasting longer than 20 MINUTES
115
what would a true sinusoidal pattern result in?
it is an emergency
intrauterine resuscitation MUST be initiated
116
intrauterine resuscitation
Interventions that aim to increase oxygenated blood flow to the fetus in times of distress.
117
fetal bradycardia
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
fetal tachycardia
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
For the client experiencing an expected labor process without pharmacologic interventions such as oxytocin to stimulate uterine contractions, the nurse must evaluate
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
what to do if fetus is having variable decelerations
change the maternal position to LATERAL POSITION to relieve cord compression and promote blood flow to uterus
121
when should intrauterine resuscitation measures be initiated?
late, variable, or prolonged decelerations
122
what measures are used to do intrauterine resuscitation? (5 things)
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
Intrauterine Resuscitation Measures: Increase Fetal Oxygenation
Maternal repositioning
Increase IV fluids
Administer supplemental oxygen for compromised maternal oxygenation status
Discontinue uterotonics
Emergent birth if indicated
124
what to do if client is experiencing uterine activity tachysystole?
stop uterotonics (like oxytocin)
if that does not work, administer a tocolytic to promote uterine relaxation
125
Tocolytic medications: what do they do?
target the smooth muscle of the uterine myometrium causing contractions to weaken, slow, or stop
126
common tocolytic medications
Terbutaline
Nifedipine
127
Terbutaline
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
Nifedipine
calcium channel blocker
ADVERSE EFFECTS:
Headache, dizziness, nausea, hypotension, fainting, edema
DO NOT take if you have hypotension
129
From class notes: what to do if someone is having late or sinsounal decels/pattern?
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
what medication to give if mom's BP is going down (and what is a common expected outcome)
Ephedrine
expected outcomes: fetal tachycardia (do not have to report this outcome or do interventions, it is expected!)
131
what are some reasons for a minimal variability in fetal HR and patterns?
minimal (<5/min)
sick, sleep, sedated
132
are accelerations on FHR tracing good or bad?
GOOD! that means the baby is oxygenated
VEAL CHOP
133
what are some pain medications to know?
Morphine
Stadol
Fentanyl
Nubain
134
what position to decrease pressure on the maternal vena cava from uterus?
later or knee to chest
135
when would you NOT want to do FSE?
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
amnioinfusion
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
when would you do an amnioinfusion?
VARIABLE decelerations
to get baby off that cord
decrease pressure on the umbilical cord
138
normal findings with fetal HR
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
normal fetal heart rate
110/160 bpm
140
abnormal findings in fetal heart rate patterns
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
fetal tachycardia accompanied by decreased variability is indicated of what?
fetal distress
we want baby earthside at the point
142
late variability tracing
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
variable decelerations tracing
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
What does moderate variability in the fetal heart rate indicate?
A healthy fetal nervous system
145
two types of pain during labor
visceral pain (organ or nerve pain)
somatic pain (muscles, joints, bones)
146
labor pain: visceral pain
uterine contractions
cervical dilation
147
labor pain: somatic pain
pelvis muscle and perineal tissue (from baby putting pressure on it)
148
pain scale for clients in labor
0-10
149
clients coping well with labor pain
moaning
rhythmic breathing
relaxation between contractions
150
clients who are not coping well with labor pain
verbalize it to nurse maybe
trouble relaxing
increasingly agitated
cry
sweat
151
how to help client who is not coping well with pain (nonpharmacological interventions)
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
what is the temp in room for when baby is about to be born
72-74 because it needs to be warm
153
how can anxiety increase pain in labor
release of catecholamines
154
labor pain nonpharmacological pain management: relaxation and breathing exercises
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
labor pain nonpharmacological pain management: positions
upright (sitting, squatting, standing)
156
what positions should the client avoid during labor as it can increase pain?
supine (like lithotomy position)
157
labor pain nonpharmacological interventions: touch and massage
counterpressure
massage
accupunture
158
how can accupuncture help with pain in labor?
removes lactic acid which improves pain
159
labor pain nonpharmacological pain management: heat and cold
back, abdomen, sacrum, perineal areas
160
labor pain nonpharmacological pain management: water thearpy
immerse in bathtub or pool or standing in water (not too hot, under 100.4)
calm muscle tension
clients between 37-42 weeks
161
when should opioids NOT be administered to labor patients
within 1 HOUR of birth
because it can cause negative impacts on the newborn's respiratory system
162
fetal adverse effects on maternal opioid use during labor
decrease in APGAR score
Increase in incidence of respiratory depression
Decrease in muscle tone
Difficulty sucking for eating
Changes in neurobehavior
163
what are two opioid agonists
fentanyl
morphine
164
what is preferable choice with opioid agonists?
fentanyl
it is fast acting and does not last long, it has minimal fetal effects
165
what should be closely monitored when given opioid angonists?
fetal heart rate (can cause a decrease in variability)
166
maternal side effects of opioid agonists?
maternal side effects:
N/V
possible respiratory depression
167
what is usually given with opioid?
antiemetic to prevent N/V
like ondansetron
also have an opioid antagonist available always
168
what to do after admin of opioid to mom?
follow-up vitals, pain, coping
safety (call light in reach) because opioids can cause hypotension, dizziness, and drowsiness
169
what to monitor after giving antiemetic?
cause constipation, so monitor for N/V, increase fluid, etc
170
what is another opioid agonist besides fentanyl and morphine?
Remifentanil
ultra-short acting
PCA pump
MONITOR CLOSELY for respiratory depression and potential need for oxygen supplementation
171
what is an opioid agonist-antagonist that can be used during labor?
Nalbuphine
172
why would you use a mixture like an opioid agonist-antagonist?
like Nalbuphine, less chance of risk for respiratory depression
173
when should opioid agonist-antagonists NOT be admined?
if client has or is receiving tx for opioid use disorder
174
what is common and okay to use opioid antagonist?
Naloxone
used for respiratory depression
175
local anesthestics for perineal repair (tearing)
lidocaine and bupivacaine
no newborn side effects because of where it is located
176
episiotomy
surg incision to kind of tear perineum to ease infant out
177
what to do with perineal infiltration?
often correlated with an episiotomy
178
pudendal block medication
during pushing or when tear is being stitched back up
179
spinal block
single injection of an opioid, local anesthetic, or combination of the two into the subarachnoid space
180
what are opioids that can be used in a spinal block
fentanyl
morphine
181
what are local anesthestics that can be used with a spinal block?
lidocaine
bupivacaine
182
epidural analgesia: what is it?
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
Medications that can be used with an epidural analgesic?
local anesthesia (bupivacaine) with OR without an opioid (fentanyl)
PCA pump as client feels pain (intermittently) or can be continous
184
contraindications to epidural
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
coagulopathy
less than 100,000 platelets
186
complications with epidural
infections
epidural hematoma
movement of catheter
severe headache
187
what to gather before epidural placement (5 things!)
vitals
O2 mask
Naloxone
crash cart
Ephedrine
188
why do you give Ephedrine to mom?
to increase BP when hypotension occurs form anesthesia (epidural)
189
what will a mom usually get before getting an epidural?
IV bolus to hopefully prevent maternal hypotension
lateral position and nurse should stand in front to provide support and encourage relaxation
190
Conditions That Require Removal of an Epidural Catheter by an Anesthesia Provider
Unexpected clotting time
Pain during removal
Resistance during removal
Suspected infection
191
when is general anesthesia used for labor pain?
emergencies only or when spinal/epidural cannot be administered
192
Complications From General Anesthesia
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
when general anesthesia is used...?
client will be preoxygenated and given either propofol
OR ketamine + succinylcholine
194
One of the reasons general anesthesia is not used often during birth is due to the
decrease in uterine tone, leading to a PPH
195
what to monitor if mom was given general anesthesia?
uterine tone (fundus)
assess for bleeding
196
how to use nitrous oxide for pain management?
inhale at the START of a contraction
197
what to remind patient about with nitrous oxide?
it will not relieve all pain
