Intrapartum Pain Management Flashcards Preview

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Flashcards in Intrapartum Pain Management Deck (19)
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1
Q

VS, FHT’s and contractions during labor are taken at what intervals:

1) Latent
2) Active
3) Transition/Second Stage

A

1) 30-60 min
2) 30 min (FHTs q 15-30 min)
3) 15 min

2
Q

How often should a woman in labor empty her bladder and why?

A

q 2 hrs because a full bladder can slow labor

3
Q

COMFORT MEASURES: Cognitive Strategies

A
  • Dick Read: conscious relaxation & breathing
  • Lamaze
  • Bradley (partner coached)
  • Hypnosis/Hypno-Birthing
4
Q

Systemic Analgesia: First Stage Opiods?

A
  • Morphine
  • Meperidine (Demerol)
  • Butophanol (Stadol)
  • Nalpbuphine (Nubain)
  • Fentanyl
  • PUT BOTH SIDE RAILS UP AFTER ADMINISTRATION
5
Q

Systemic Analgesia: First Stage Antiemetics

A
  • usually given w/ Opioids
  • Vistaril
  • Phenegran
  • Compazine
6
Q

Effects of Analgesics on the fetus?

A

decreased variability of FHT’s

7
Q

Effects of Analgesics on the newborn?

A

Decreased attention, social responsiveness & breast feeding initiation

8
Q

Types of OB Anesthesia?

A
  • local
  • pudendal
  • regional (epidural)
  • spinal
  • general
9
Q

Effects of Analgesics on the Mother?

A
  • Diminishes pain perception
  • May effect progress of labor (timing)
  • Relaxation
  • Drowsy
  • Transient hypotension
  • N&V
  • Dry mouth
  • Respiratory depression
  • Disappointment, failure of expectations
10
Q

Maternal A/E’s from regional (epidural) anesthesia?

A
  • Transient hypotension (fetal bradycardia)
  • Urinary retention
  • Pelvic relaxation
  • Risk of injury
  • Loss of urge to push (increased chance of operative birth)
  • Itching
  • Elevated Temperature
    • need fetal & septic work up
11
Q

What are the most common pain meds given during labor?

A
  • Butophanol (Stadol)

- Nalpbuphine (Nubain)

12
Q

The “Cascade of Interventions” needed after an epidural include?

A

IV, CEFM, foley, bedrest, limit position choices

13
Q

Nursing Care: Prior to Epidural

A
  • Informed consent
  • Instruct patient
  • IV preload with 500-1000 ml of dextrose-free solution (bolus) Lactated Ringers
  • Monitor fetus
  • Monitor VS
14
Q

Nursing Care: During epidural

A
  • Support in sitting or side-lying position with back arched outward, shoulders rolled, hips even during procedure.
  • Assist patient to remain still
  • Assist with breathing
  • Emotional support
15
Q

Nursing Care: Following an epidural

A
  • Position of left side or back with left tilt
  • Observe for signs of systemic administration
  • Monitor maternal VS
  • Monitor fetus
    O2 available as needed, 7-10 l/min
16
Q

Maternal VS should be monitored how often following an eipdural?

A

Q 2 min x 5, then Q 5 min x 3, then Q 15 in x 3

17
Q

Nursing Care: Ongoing care following an epidural

A
  • Check bladder q 1h
  • Cath (or indwelling cath) q 2h or as needed
  • Position with good alignment. Watch for pressure points. Change position.
  • Watch for signs of labor progress.
  • Assist with pushing.
  • Perineal dose sometimes administered for delivery.
18
Q

Maternal dangers from general anesthesia?

A

aspiration & bleeding

19
Q

Fetal dangers from general anesthesia?

A

respiratory depression