CH 12 Pain Mgmt Flashcards Preview

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Flashcards in CH 12 Pain Mgmt Deck (15):
1

What is sacral counter pressure

Consistent pressure provided by the support person using the heel of the hand or fist against the clients sacral area to counteract pain in the lower back

2

Sedatives (barbiturates), such as secobarbital ( Seconal), pentobarbital ( Nembutal) and phenobarbital ( Luminal) should be used at what time during the labor process

They are not typically used during birth, but they can be used during the early or latent phase to relieve anxiety and induce sleep

3

What are adverse effects of sedatives

Neonate respiratory depression secondary to the medicine crossing the placenta and affecting the fetus.
Unsteady gait
Inhibitions of mothers ability to cope with the pain of labor

4

What are opioids such as meperidine hydrochloride ( Demerol), fentanyl ( Sublimaze), butorphanol ( Stadol) and nalbuphine ( Nubain) action?

They act in the CNS to decrease the perception of pain without the loss of consciousness.
It may be given IM or IV, the IV route is recommended because it has a faster effect

5

What are adverse effects of opioid analgesics

Crosses the placental barrier, if given to mother too close to the time of delivery
Can cause respiratory distress in the neonate
Reduces gastric emptying time; increases risk for N/V
Increases risk of aspiration of food and fluids in the stomach
Sedation, hypotension, tachycardia, allergic reaction
Decreased FHR variability

6

What 2 opioid analgesics can be administered that will provide pain relief without causing significant respiratory depression in the mother or fetus.

Butorphanol ( Stadol) and nalbuphine ( Nubain) can be given IM or IV

7

Prior to administering analgesics, what should the nurse verify

Verify that labor is well under established by performing a vaginal exam that reveals cervical dilation of at least 4 cm with a fetus that is engaged
Administer antiemetic a as prescribed
Monitor vital signs, uterine contractions pattern, continuous FHR monitoring

8

What 2 meds are used as an adjunct with opioids to control Nausea and anxiety.

Ondansetron ( Zofran) and metocloclopramide ( Reglan). They do not relieve pain

9

What is a epidural and spinal regional anesthesia

It consists of using analgesics such as fentanyl ( Sublimaze) and sufentanil ( Sufenta) which are short acting opioids that are administered as a motor block into the epidural or intrathecal space without anesthesia.
They produce regional anesthesia providing rapid pain relief while still allowing the client to sense contractions and maintain the ability to bear down.

10

What are adverse effects of epidural and spinal analgesia

Decreased gastric emptying results in N/V
Inhibition of bowel and bladder elimination sensations
Bradycardia or tachycardia
Hypotension, respiratory depression, allergic reaction and pruritis, elevated temp

11

The spinal block eliminates sensation where

From the level of the nipples to the feet. Commonly used for C Sections

12

When are spinal blocks administered

Late in the second stage or before a C Section

13

What are adverse effects of a spinal block

MAternal hypotension
Fetal bradycardia
Loss of bearing down reflex
Potential headache from leakage of cerebrospinal fluid at the puncture site
Higher incidence of maternal bladder and uterine agony following birth

14

What are nursing assessment for a spinal block

Maternal vital signs Q 10 min
Manage maternal hypotension by administering IV fluid bonus as prescribed
Assess uterine contractions/FHR patterns, level of anesthesia
Recognize signs of impending labor

15

What is effleurage

Light gentle circular stroking of the clients abdomen with the fingertips in rhythm with breathing during contractions