Pain Management

Question 1

relieves anxiety and induce sleep

NOT used during labor for various reasons

Answer 1

sedatives

Question 2

given by anesthesia (IV or IM opioid)

given due to epidural contraindication or if pt asks for it

Answer 2

systemic analgesia

Question 3

what are the epidural contraindications that would cause systemic analgesia to be used

Answer 3

MRSA, spinal surgery, idiopathic thrombocytopenia

Question 4

what is the opioid (narcotic) agonist analgesic

Answer 4

better pain relief (IV)

Fentanyl

Question 5

what is the number one thing to remember with opioids

Answer 5

NEVER give 1 hr prior to delivery due to neonatal respiratory depression

Question 6

what is opiod agonist-antagonist analgesic

Answer 6

Stadol and Nubain

**again watch for respiratory depression if given an hour before delivery

Question 7

what negative side effects does Stadol have

Answer 7

hallucinations and dizzy

Question 8

what negative side effects does Nubain have

Answer 8

similar to a morphine type response

Question 9

what is the nursing PRIORITY when giving analgesic/opioids

Answer 9

SAFETY

Question 10

what is the opioid antagonist

Answer 10

Narcan

Question 11

describe Narcan nursing responsibility

Answer 11

always have available if giving opiod

**expect withdrawal response if given to drug user

Question 12

what is the maternal opioid abstinence syndrome

Answer 12

withdrawing from opioids as a mother

Question 13

what are the s/s of maternal opioid abstinence syndrome

Answer 13

yawning, runny nose, lacrimal tearing, sweating, dilation of pupils, anxiety, N/V/D, and **tremors
OR go straight into seizures

Question 14

what is is important to remember with opiods and Narcan

Answer 14

use extreme caution

Question 15

used for C section

given higher up in spine

Answer 15

spinal block

Question 16

what is given for local perineal infiltration anesthesia and why

Answer 16

Lidocaine

perineum for repair after delivery

Question 17

what is given for pudendal nerve block and why

Answer 17

Lidocaine injection in pudenal nerve
administered during second stage of labor for pain relief
*rarely given

Question 18

when is Lidocaine injection given

Answer 18

second stage of labor OR 10-20 min before vacuum, episiotomy, delivery

Question 19

spinal anesthesia compared to epidural block

Answer 19

spinal= C-section, blocks more (L3-L4), given higher up in spine
epidural= vaginal, blocks less (L4-L5)

Question 20

risks of spinal anesthesia(block)

Answer 20

postdural headache

epidural blood patch

Question 21

what to do if spinal headache due to CFS leak

Answer 21

lay pt flat, pull blood from arm, inject blood into leak to form a clot (blood patch), and give fluids to prevent leak

Question 22

this provides no uterine relief, only perineal relief

Answer 22

pudendal nerve

Question 23

given in spinal column, below spinal cord

decreases pain during uterine contractions

Answer 23

epidural anesthesia

Question 24

how is gravity used with epidural anesthesia

Answer 24

to bathe all nerves
ie/ if more relief felt on right side, catheter is probably leaning right so lay pt on left side to bathe nerves with medicine on left side

Question 25

nursing interventions prior to epidural anesthesia

Answer 25

``` evaluate hx of spinal surgery evaluate skin for lesions evaluate CBC for platelet ct (want it >100,000) obtain consent for anesthesia *preload pt with NS/LR ```

Question 26

what is the most important nursing intervention prior to epidural anesthesia

Answer 26

preload pt with 500 mL to 2 L of NS/LR

Question 27

what is the most common side effect of epidural

Answer 27

hypotension due to sympathetic blockade | and vasodilation with pooling of blood in the lower extremities, decreased cardiac output

Question 28

what is the target of the epidural

Answer 28

``` epidural space (negative space) do NOT go into spinal column, will lead to a CSF leak ```

Question 29

what position to sit in during epidural administration

Answer 29

knee to chest position | sitting on side of bed (hunched over)

Question 30

epidural anesthesia used to ______

Answer 30

keep pt awake

Question 31

general anesthesia used to ____

Answer 31

put pt to sleep