Flashcards in Pharmacological Pain Management: Sherpath Deck (39):
Special Considerations When Medicating a Pregnant Woman
Decreased respiratory capacity
Slowed peristalsis and decreased GI absorption
Analgesics may slow the progress of labor
a drug that relieves pain. The opioid analgesics act on the CNS and alter the patient's perception; they are more often used for severe pain. The nonopioid analgesics act primarily at the periphery, do not produce tolerance or dependence, and do not alter the patient's perception; they are used for mild-to-moderate pain.
the absence of sensation and consciousness as induced by various anesthetic medications, given by inhalation or IV injection.
Nursing Considerations for Nitrous Oxide
Nurses should let women know that they may experience side effects of dizziness, nausea and vomiting, or dysphoria (Stewart & Collins, 2013).
Nurses should advise a laboring woman that the drug is a gas that must be inhaled through a mask.
The mask must have a demand valve so delivery of the drug stops while the patient is not inhaling.
(in physiology) any agent, such as a drug or muscle, that exerts an opposite action to that of another or competes for the same receptor sites.
Intrathecal Opioid Analgesics: Nursing Considerations
Does not cause maternal sedation.
Only a very small dose is needed.
Common side effects include nausea, vomiting, and pruritus.
Report side effects to anesthesia; have naloxone or naltrexone available.
Monitor for delayed respiratory depression depending on the drug given.
Observe and report nonreassuring fetal heart rate patterns.
Systemic Opioid Analgesics: nursing Considerations
Assess women for drug use and dependence at admission to avoid mixing opioid agonist and antagonist drugs.
Monitor neonates for a delay in initiating or sustaining spontaneous respirations, respiratory rate < 30 breaths/min, and poor muscle tone.
Have naloxone available for newborns exposed to opioids during labor.
Epidural Opioid Analgesics: Nursing Considerations
Do not give additional opioids or other CNS depressants except as ordered.
May be administered with nonsteroidal anti-inflammatory drugs.
Observe for delayed respiratory depression: Monitor respiratory rate, depth, oxygen saturation, and arousability hourly for 24 hr. Have naloxone available.
Notify anesthesia provider of a rate of <12 breaths per minute, persistent oxygen saturation of <95%, or difficulty arousing.
Local Infiltration Anesthesia: Nursing Considerations
Local anesthetic: Used to numb perineum for episiotomy or laceration repair
Assess for drug allergies, especially to local dental anesthetics.
Pudendal Block: Nursing Considerations
Local anesthetic: Used to numb the perineum and lower vagina; useful for instrument-assisted births
Assess for drug allergies, especially to local dental anesthetics.
a drug or other substance having a specific cellular affinity that produces a predictable response.
A nurse is caring for a patient in the first stage of labor who received intrathecal opioid analgesics for pain relief from uterine contractions. The nurse observes for which common side effects of these drugs?
Pruritus: is a common side effect of intrathecal opioid analgesics. These drugs may be used throughout the first stage of labor and require only a very small dose injected into the subarachnoid space. These drugs allow the mother to feel her contractions, but not the pain.
Vomiting: is a common side effect of intrathecal opioid analgesics. These drugs may be used throughout the first stage of labor and require only a very small dose injected into the subarachnoid space. These drugs allow the mother to feel her contractions, but not the pain.
Nausea: is a common side effect of intrathecal opioid analgesics. These drugs may be used throughout the first stage of labor, and require only a very small dose injected into the subarachnoid space. These drugs allow the mother to feel her contractions, but not the pain.
A woman in labor is given fentanyl for pain. Which vital sign is a priority for the nurse to monitor in the newborn infant?
Opioid analgesics can cause respiratory depression, which is more likely to occur in the newborn than in the mother, and respiratory rate should be monitored.
A woman is administered fentanyl during labor and is still experiencing significant pain. Which order from the provider would the nurse anticipate for administration?
The nurse anticipates an order for nitrous oxide, which can be administered to a woman who is still experiencing pain after the administration of fentanyl.
for intrapartum analgesia, anesthesia, or both. These methods provide pain relief without loss of consciousness. Regional anesthesia includes epidural block, intrathecal (subarachnoid) opioid analgesic injection, subarachnoid (spinal) block and combined spinal-epidural anesthesia. The major advantage of regional pain management methods is that the woman can participate in birth yet still have good pain control. The woman usually feels some pressure and discomfort, although these sensations are greatly reduced.
Contraindications: Epidural Block
Contraindications and precautions include the woman’s refusal, coagulation defects, uncorrected hypovolemia, an infection in the area of insertion or a severe systemic infection, allergy, or a fetal condition that demands birth sooner than the block can become effective.
Maternal Hypotension: EB
An adverse effect of an epidural block is maternal hypotension. Sympathetic nerves are blocked along with pain nerves, which may result in vasodilation and hypotension. Intravenous fluids are administered prior to epidural insertion to reduce hypotension.
Bladder Distention: EB
Bladder distention is another adverse effect of an epidural block. A woman’s bladder fills quickly because of the large quantity of IV solution, yet her sensation to void is reduced. Continuous or intermittent bladder catheterization is usually required, increasing risk of infection.
Prolonged Second Stage: EB
The urge to push is often less intense with reduced sensation. Forceps- or vacuum extractor-assisted births are more likely because of the reduced urge to push.
Migration of the Epidural Cath: EB
Migration of the epidural catheter is another potential adverse effect. The catheter may move after accurate placement. A woman may then have symptoms of intravascular injection, an intense block or one that is too high, absence of anesthesia, or a unilateral block.
Another adverse effect is a fever. Fever with no apparent infection may occur in a woman who has epidural analgesia, and its cause is not clear. The neonate’s temperature may be elevated as well possibly leading to unnecessary treatment for neonatal sepsis.
Contraindications: Subarachnoid Spinal Block
Contraindications and precautions are similar to those for epidural block: the woman’s refusal, coagulation defects, uncorrected hypovolemia, infection in the area of insertion, systemic infection, allergy, or possibly prior spinal surgery.
Averse Effects: SAB
Three adverse effects of an SAB are maternal hypotension, bladder distention, and spinal headache. Hypotension occurs because of sympathetic blockade as in epidural block but can be more severe. Treatment is the same, but a larger preload of IV fluid is common.
Postspinal headache may occur after SAB in some women because of cerebrospinal fluid leakage at the site of dural puncture. A spinal headache is postural; it is worse when a woman is upright and may disappear when she is lying flat. The incidence of spinal headache is lower if a small-gauge needle is used.
Regional Anesthesia: Combined Spinal-Epidural Block
Rapid onset of pain relief without sedation
No motor block, enabling the woman to ambulate during labor (unless she receives a concurrent epidural block)
No sympathetic block, with its hypotensive effects
Dural puncture leads to potential for post-dural headache
Vaginal Birth Anesthesia (Local Infiltration Anesthesia): Consideration
For cutaneous pain in the immediate area of an episiotomy or laceration
Rarely has adverse effects on either mother or infant
Does not alter pain from uterine contractions or from distention of the vagina
Performed by health care provider just before performing an episiotomy or suturing a laceration
Vaginal Birth Anesthesia (Local Infiltration Anesthesia): Patient Teaching
There will be a short delay between anesthetic injection and the onset of numbness
It may burn before the anesthetic action begins
Vaginal Birth Anesthesia (Pudendal Block): Considerations
Anesthetizes the lower vagina and part of the perineum before an episiotomy
Often used in anticipation of the need for an instrument-assisted vaginal birth
Risk of maternal complications including a toxic reaction to the anesthetic, rectal puncture, hematoma, and sciatic nerve block (if maternal toxicity is avoided, the fetus is usually not affected)
Does not block the pain from uterine contractions
Vaginal Birth Anesthesia (Pudendal Block): Patient Teaching
The block is used to numb part of the vagina and perineum, but the mother will continue to feel pressure
An inflammatory condition of the lungs and bronchi caused by inhaling foreign material or acidic vomitus.
A nurse is caring for a patient who undergoes general anesthesia. Which adverse effects associated with general anesthesia should the nurse monitor for?
Uterine relaxation: The nurse should monitor for uterine relaxation, which is an adverse effect of general anesthesia.
Respiratory depression: The nurse should monitor for respiratory depression, which is an adverse effect of general anesthesia.
Maternal aspiration of gastric contents: The nurse should monitor for maternal aspiration of gastric contents, which is an adverse effect of general anesthesia.
Which order would the nurse expect to administer to a patient at high risk for maternal hypotension prior to epidural anesthesia?
Intravenous fluids: The nurse would anticipate intravenous fluids, which should be administered prior to epidural anesthesia.
A nurse is caring for a patient who has a contraindication for spinal anesthesia. Which is a contraindication for spinal anesthesia?
Infection at the site of insertion: Contraindications and precautions include the woman’s refusal, coagulation defects, uncorrected hypovolemia, infection in the area of insertion, systemic infection, allergy, or possibly prior spinal surgery.
A patient experiences nausea and vomiting during labor. Which medication might the nurse anticipate administering?
Promethazine: The nurse would anticipate promethazine because it relieves the nausea and vomiting that may occur when opioid drugs are given.
Which statement does the nurse use to describe to the patient’s partner why opioid analgesics are being administered?
“Opioid analgesics help the mother relax between contractions.”: The nurse explains that opioid analgesics affect the perception of pain, allowing the mother to relax during contractions.
A patient has received fentanyl, and her respiratory status is rapidly declining. Which medication would the nurse anticipate administering to counteract the effects of this drug?
Naloxone: Naloxone counteracts opioid-induced respiratory depression.
A patient arrives at the Labor and Delivery unit with steady contractions and is 5 cm dilated. On assessment, the fetal heart rate is 200 beats per minute, and it is determined that a cesarean delivery should be performed. Which anesthesia method does the nurse anticipate?
Subarachnoid (spinal) block: The nurse would anticipate a subarachnoid block (SAB), because it is recommended when a quick cesarean birth is necessary and an epidural catheter is not in place.
Match the patient with the appropriate type of anesthesia.
Patient who requires a vaginal laceration repair after delivery
Patient in labor who would like pain relief and to be awake for the birth
Patient who has an active skin infection on back and requires an emergency cesarean delivery
Patient in labor who would like to have pain relief but still feel contractions and be able to move
**Combined spinal-epidural anesthesia
A nurse is caring for a patient who needs general anesthesia. What statement most describes this patient?
Patient refusing regional and local anesthetic methods and needs a cesarean delivery
A patient who refuses regional and local anesthetic methods and needs a cesarean delivery does require general anesthesia.