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Nurs 368 > Pharmacological Pain Management in Labor > Flashcards

Pharmacological Pain Management in Labor Flashcards

1
Q

What does PAIN stand for in labor?

A

P- Purposeful
A- Anticipated
I- Intermittent
N- Normal

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2
Q

What will happen physiologically to a woman who is experiencing excessive labor pain?

A

increase in metabolic rate and increase in the demand for oxygen, increase in cortisol and glucagon, and a release of catecholamines

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3
Q

What does increasing catecholamines do when a woman is in labor?

A

inhibits the uterine response to oxytocin

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4
Q

What can unrelieved pain during labor lead to?

A

PTSD and PPD

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5
Q

What are the 4 main sources of pain during labor?

A

tissue ischemia, cervical dilation, pressure/pulling on pelvic structures, distention of the vagina/perineum
(burning, tearing, splitting-somatic pain)

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6
Q

What is visceral pain during labor?

A

cramp-like or throbbing feeling that results from the contraction of the uterus and originates in the uterus and cervix

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7
Q

What caused somatic pain in labor?

A

skin and deep tissue pain that results from the distention of the vagina, perineum, pelvic floor, and stretching of ligaments in the pelvis, and is normally sharp and localize
(rectal pressure may also occur)

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8
Q

What are some factors that influence pain?

A

intensity of labor, fetal position and size, characteristics of pelvis, fatigue, medical interventions, culture, anxiety and fear, previous experiences with pain, support system, and preparation for childbirth

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9
Q

What scale is used to determine pain during labor?

A

PQRSTU

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10
Q

What is a downside of administration of certain pain medications that are given during labor?

A

may slow down labor or increase the length of the 2nd stage

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11
Q

What are the different types of regional pain management?

A

regional anesthesia, pudendal block, local infiltration anesthesia, epidural block, combined spinal-epidural, subarachnoid block/spinal

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12
Q

What is the advantage of regional pain management during labor?

A

the woman participates in her birth experience, may have good pain control, no loss of consciousness, can interact with her partner and infant, and she retains her airway reflex

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13
Q

What is the difference between analgesia and anesthesia?

A

analgesia is utilized for pain relief
anesthesia will cause a loss of sensation locally, regionally, or generally

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14
Q

When would a pudendal nerve block be used?

A

second stage of labor

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15
Q

Why is a pudendal block not used much anymore?

A

increases the risk of infection and puts the mother at risk for urinary retention

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16
Q

When is local infiltration anesthesia used for a woman?

A

When prepping for/repairing an episiotomy or when repairing a laceration

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17
Q

Where will local infiltration anesthesia be injected?

A

perineum

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18
Q

What are the advantages of using a Q pump for pain management during labor?

A

it will only numb a targeted site, it is a small disposable pump, it will continuously deliver medication, pump is connected to a catheter which can be removed at home, faster recovery for patient, better pain relief without side effects of narcotics

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19
Q

What are the side effects of the Q pump?

A

increase in pain, fever, chills, sweats, bowel/bladder changes, difficulty breathing, redness/warmth/discharge/excessive bleeding from catheter site, pain/swelling/large bruises around catheter site, dizziness/lightheadedness, numbess/tingling around site, drowsiness, confusion

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20
Q

Who administers an epidural block?

A

anasthesiologist

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21
Q

Is an epidural block a sterile or clean procedure?

A

sterile

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22
Q

What sensations will a patient still feel after administration of an epidural?

A

touch and pressure, but not cold or cramping

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23
Q

Is an epidural usually administered by itself?

A

no. It is usually in combination with analgesics

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24
Q

What are disadvantages of an epidural block?

A

may cause maternal hypotension, may be one sided or not work at all, will limit mobility, nausea/vomiting, bladder distention, elevation in maternal temperature and pruritis, may prolong labor/pushing

25
Q

Where is an epidural catheter placed (by an anesthesiologist)?

A

into epidural space (between the dura and spinal canal) and is outside the dura mater between 4th and 5th lumbar vertebrae

26
Q

Can nurses manage epidural flow?

A

No. Nurses monitor the epidural drip, but cannot manage it

27
Q

When is a spinal block used in a laboring woman?

A

primarily for scheduled C-sections

28
Q

When does the onset of a spinal block happen and how long will the pain relief last once administered?

A

onset: 5 minutes after administration
Lasts for 90 minutes to 3 hours

29
Q

What are the most common adverse side effects of a spinal block?

A

maternal hypotension, bladder distention, and spinal headache (may also cause fetal bradycardia)

30
Q

When should a fluid bolus be administered during an epidural administration or a spinal block?

A

before procedure (if ordered)

31
Q

What is the nursing role in epidural/spinal block administration?

A

provide fluid bolus, time-out, informed consent, assist with patient positioning, assess for side effects upon administration, frequent vital signs/pulse ox/FHR, anticipate placing a urinary catheter, and assess effectiveness

32
Q

What may happen if an epidural catheter migrates?

A

symptoms of an IV infection may occur, an epidural may be too intense or inadequate

33
Q

What kind of deceleration would you expect to see with uteroplacental insufficiency?

A

late

34
Q

When should you be concerned that a baby will have respiratory depression after the administration of an epidural?

A

If the baby is born within 1 hour of the administration of the epidural

35
Q

When should you be concerned that a baby will have respiratory depression after the administration of an epidural?

A

If the baby is born within 1 hour of the administration of the epidural

36
Q

When does hypotension normally occur once an epidural is administered?

A

within 15 minutes

37
Q

What percentage of laboring mothers will experience hypotension from an epidural?

A

40%

38
Q

If an epidural is administered, what is important to educate the mom about prior to administration?

A

An epidural can prolong labor, it may only work on one side, there is a chance that it will not work at all, nausea and vomiting may occur

39
Q

After an epidural administration, the vitals on the mother are: BP- 100/60, HR- 70 bpm, Temp- 100.2, what are the most important nursing interventions?

A

Turn pt on her left side, increase the IV rate, administered O2 (AS ORDERED), and notify anesthetist/anesthesiologist

40
Q

A pt is still in pain 15 minutes after epidural administration, she asks you to increase her epidural rate to treat the pain. How do you respond?

A

Inform the pt that the epidural normally does not take effect for 20-40 minutes, but if it hasn’t taken effect after 40 minutes, you can notify the anesthesiologist, but you cannot manage the epidural

41
Q

A patient is administered an epidural and suddenly is experiencing SOB, what is the first nursing intervention to be done?

A

Position the patient in a High Fowler’s position

42
Q

What is normally a standing order given when Duramorph is administered?

A

narcan

43
Q

When should a fluid bolus be given when an epidural/spinal is being given?

A

BEFORE the procedure

44
Q

A pt is dilated at 10cm and has been administered an epidural, contractions are frequent with a long duration, but pt is not feeling the urge to push, why would this happen?

A

A decreased feeling to push, also known as the Ferguson reflex is extremely common with an epidural, because nerves are blocked and the mom does not feel the contractions

45
Q

A laboring mom is requesting an epidural. You look through her history and notice there a contraindication to epidural administration. What could you have seen in her chart?

A

History of back surgery, scoliosis, taking anticoagulants such as warfarin, or thrombocytopenia

46
Q

If a laboring mom has an epidural on her birth plan, what is important to assess on a physical assessment prior to calling the anesthesiologist?

A

If there is a rash or infection on the back

47
Q

You give a pt nitrous oxide to help with labor pains. She asks what Nitrous Oxide is made of and how she is supposed to take the medication. How do you educate the pt for this?

A

Nitrous Oxide is 50% Oxygen and 50% nitrous oxide
It will be inhaled through a hand held mask

48
Q

A laboring mom is in a lot of pain, and the physician says you can offer her nitrous oxide to help with the pain. The pt tells you that she doesn’t want to take that medication because she heard that it can cause respiratory depression in her baby, and she doesn’t want that to happen. How wold you educate you patient about this?

A

Certain pain medications can cause respiratory depression as a side effect, but nitrous oxide does not have that side effect on the baby

49
Q

A pt comes in and is having extremely painful contractions. The pt has a hx of opioid abuse. She does not want any opioids administered during the delivery. What drugs that are commonly given to laboring mothers will you make sure to avoid for this pt?

A

morphine, fentanyl, demerol, nubain, and stadol

50
Q

Why is demerol not commonly used anymore as a systemic analgesic during a delivery?

A

It has a prolonged half life and will last for about 2.5 days in the baby

51
Q

When does demerol peak in an infant?

A

2-3 hours after administration to the laboring mom

52
Q

A physician has ordered morphine to give to the pt to alleviate pain. When discussing this will the pt, she tells you that she’s glad she’s being given morphine, because she heard that opioids do not affect the baby. How do you educate this mom?

A

opioids do cross the placenta and affect the baby, but it is short lasting, and morphine will peak with its effects after only 20 minutes

53
Q

Your patient is debating on what type of pain medication that she would like to be given, she has been offered fentanyl or epidural, but she says that she wants the one that is going to be the best at alleviating the pain. How do you educate the pt?

A

Epidural is usually more effective since it is a regional anesthesia, but it takes about 20-40 minutes to take effect
Fentanyl is a systemic analgesic so it will act quicker (1-3 minutes), but it will not be as effective at alleviating all of the pain

54
Q

A pt was given morphine to help with her pain, you are taking her vitals and they are: BP- 114/88, HR- 99 bpm, RR- 8, and Temp- 98.7. What is the most important nursing intervention?

A

Administer Narcan!!

55
Q

If you administer Narcan to a pt, what is important to remember about how it works relatively to opioids?

A

It has a shorter duration of action than the opioids that it reverses

56
Q

If you administer narcan to a pt, what side effects should you be monitoring?

A

Nausea/vomiting, tremors, tachycardia, hypo/hypertension, v-fib, seizures, cardiac arrest

57
Q

You received an order for promethazine. How are you preparing the med? How are you administering the med?

A

Mix the promethazine with normal saline and push it SLOWLY

58
Q

What needs to be monitored if pitocin is administered?

A

FHR

59
Q

What must always be given when pitocin is administered through an IV?

A

IV FLUIDS!!

Nurs 368 (20 decks)

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