T2 - Mgmt of Discomforts PPT (Josh) Flashcards
— is light stroking of abdomen or back in rhythm with the patient’s breathing during a contraction.
Effleurage
— is steady pressure applied to sacral area…Especially helpful when back pain is caused by the baby in the occiput posterior position…
Counterpressure
***Lifts the occiput off the nerves and provides some relief.
What is the purpose of Controlled Breathing Techniques?
Provides distraction and reduces perception of pain during UC
In 1st Stage, it increases size of abdominal cavity and promotes fetal descent
In 2nd Stage, it assists in bearing down by increasing abdominal pressure
How should they breathe?
iN through Nose
OUT through mOUTh
When is the Pant-Blo breathing used?
8-10 cm
s/e: can cause hyperventilation and Resp Alkalosis
What are S/E of Respiratory Alkalosis?
Lightheaded
Dizzy
Tingling of Fingers
Numbness/Blueness
***blow into paper bag or cupped hands
What breathing pattern is encouraged to reduce chance of Respiratory Alkalosis?
no more than 2 x’s the normal rate
When would we give butorphanol (Stadol)?
at top of contraction to increase perfusion to mom and decrease to baby
What determines the type of analgesia or anesthesia?
Stage/Phase and Progress of Labor
Why are Barbituates used?
to relieve anxiety and induce sleep
may be administers in early labor to alter a dysfunctional pattern
NOT used in active labor b/c of CNS depression in newborn
Which class of drugs are NOT used?
Benzos
- disrupt newborn thermal regulation
Examples of Pure Opioids
Hydromorphine (Dilaudid)
Meperidine (Demerol)
Fentanyl (Sublimaze)
Sufentanil (Sufenta)
Should Hydromorphine be given during labor?
Try NOT to give during active labor, but before is OK
Onset of — is almost immediate if given IV and 10-20 mins if IM.
Meperidine (Demerol)
***lasts 1.5 - 2 hrs
***not used as much b/c of effects on baby [sedation, neuro changes than can last 2-3 days]
When using Opioids, what should we have available for antidote?
Naloxone (Narcan)
***antagonist that reverses CNS depressant effects
***contraindicated for narcotic addicted patients b/c may precipitate withdrawal symptoms
What type of drug butorphanol tartrate (Stadol)?
Mixed Opioid Agonist-Antagonist
***Naloxone will NOT reverse effects
Which drugs provide adequate analgesia w/out respiratory depression in mom or baby?
Mixed Opioid Agonist-Antagonists
- butorphanol tartrate (Stadol)
- nalbuphine hydrochloride (Nubain)
What is one problem with Mixed Opiod Agonist-Antagonists like Stadol?
may precipitate withdrawal symptoms in narcotic dependent women and baby
Advantages of Epidurals
Patient remains alert
Good relaxation is achieved
Only partial motor paralysis
Airway reflexes remain intact
Gastric emptying is not delayed
Blood loss is not excessive
Disadvantages of Epidural
Limited Mobility
May increase duration of 2nd stage of labor
Not effective for some patients
Urinary retention
Pruritus (ithcing)
High/Total Anesthesia
Epidural blocks are a combination of — and —-
-caine’s and opiods
When would an Epidural be administered?
after labor is well established (5-7 cm)
Where is the Epidural Space?
outside the dura mater b/t the dura and the Spinal Column
Which vertebrae is the needle inserted through with an epidural?
L2-L5 (L3-L4 mostly)
