OB caring for pt w labor epidural Flashcards Preview

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Flashcards in OB caring for pt w labor epidural Deck (66)
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1

An epidural is important for blunting the HD effects from contractions in what sub populations?

mitral stenosis, spinal cord injury, intracranial neuro vascular lesions, preeclampsia

2

Absolute contraindications for laboring epidural?

refusal, uncooperative, increased ICP, infection at site of needle placement, frank coagulopathy, severe hypovolemia, anticoag therapy, decreased FHR variability or late decels, known allergy to med given

3

Relative contraindications to laboring epidural?

systemic maternal infection, preexisting neuro deficiency, mild or isolated coagulation abnormalities, relative hypovolemia, poor staffing

4

Moving towards the spinal cord from the epidural space, what are the 4 membranes that cover the spinal cord going from outermost to innermost?

dura, arachnoid, subarachnoid, pia mater

5

This is the outermost layer covering the nerve roots

dura mater

6

This layer is thin, spider like and forms the middle layer

arachnoid mater

7

This layer beneath the arachnoid matter and filled w CSF?

subarachnoid mater

8

This is the innermost layer and adheres tightly to the spinal cord and brain

pia mater

9

When opioids and LA are used for epidurals, they collect in?

the fat

10

Epidural space contains?

fat, epidural veins, lymphatics, segmental arteries, nerve roots

11

Medications used in epidurals act on receptors in the?

dorsal horn by diffusing across meninges and CSF

12

C6 dermatome?

thumb

13

C8 dermatome?

ring/little finger

14

T 4 dermatome?

nipple line

15

T6 dermatome?

xiphoid line

16

T 10 dermatome?

umbilicus

17

S2, S3, S4 dermatome?

perineal

18

Poss situations causing inadequate pain coverage w epidural placement?

BMI >30, short or tall, previous spinal surgeries, variety of musckuloskeletal disorders, hx of previous epidural, radicular pain during placement, posterior presentation of the fetus, labor >6 hours

19

some troubleshooting suggestions for unsatisfactory labor epidural?

manipulate epidural catheter, add more LA, reposition, replace epidural, single shot spinal, continuous spinal, combined spinal epidural, place additional epidural, IV meds

20

Some causes of an adequate level but insufficient density of block?

not enough time, loss of LA (volume), inadequate % of LA, pt overexpectations

21

Some causes of satisfactory density but inadequate segmental level?

small vol of LA, insufficient time, loss of LA, anatomical features such as previous surgery, allow more time, additional epidural

22

Causes of not working epidural that had been working?

migration in to subarachnoid space (total spinal), intravascular, laterally (unilat block), completely out, labor progression, dysfunctional labor, pt perception changed

23

If pt has a lateral/one side block, what is something you can try?

have patient lie painful side down and bolus while lying

24

What can you do to troubleshoot an epidural that was working and is currently not?

catheter exam, redose, give more volume, add opioids, % LA, replace

25

Epidurals are typically placed at what level?

L3-4, L4-5

26

T10-L1 innervates what organs?

uterus, cervix, upper portion of vag

27

S2-S4 innervates what part of body?

perineum

28

First stage labor pain is visceral or somatic?

visceral

29

Second stage labor pain is visceral or somatic?

somatic

30

Epidural infusions tend to go up or downward more readily?

upward