T2 - Mgmt of Discomforts PPT (Josh) Flashcards Preview

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Flashcards in T2 - Mgmt of Discomforts PPT (Josh) Deck (52):
1

--- is light stroking of abdomen or back in rhythm with the patient’s breathing during a contraction.

Effleurage

2

--- 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.

3

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

4

How should they breathe?

iN through Nose

OUT through mOUTh

5

When is the Pant-Blo breathing used?

8-10 cm

s/e: can cause hyperventilation and Resp Alkalosis

6

What are S/E of Respiratory Alkalosis?

Lightheaded

Dizzy

Tingling of Fingers

Numbness/Blueness

***blow into paper bag or cupped hands

7

What breathing pattern is encouraged to reduce chance of Respiratory Alkalosis?

no more than 2 x's the normal rate

8

When would we give butorphanol (Stadol)?

at top of contraction to increase perfusion to mom and decrease to baby

9

What determines the type of analgesia or anesthesia?

Stage/Phase and Progress of Labor

10

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

11

Which class of drugs are NOT used?

Benzos

- disrupt newborn thermal regulation

12

Examples of Pure Opioids

Hydromorphine (Dilaudid)

Meperidine (Demerol)

Fentanyl (Sublimaze)

Sufentanil (Sufenta)

13

Should Hydromorphine be given during labor?

Try NOT to give during active labor, but before is OK

14

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]

15

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

16

What type of drug butorphanol tartrate (Stadol)?

Mixed Opioid Agonist-Antagonist

***Naloxone will NOT reverse effects

17

Which drugs provide adequate analgesia w/out respiratory depression in mom or baby?

Mixed Opioid Agonist-Antagonists

- butorphanol tartrate (Stadol)
- nalbuphine hydrochloride (Nubain)

18

What is one problem with Mixed Opiod Agonist-Antagonists like Stadol?

may precipitate withdrawal symptoms in narcotic dependent women and baby

19

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

20

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

21

Epidural blocks are a combination of --- and ----

-caine's and opiods

22

When would an Epidural be administered?

after labor is well established (5-7 cm)

23

Where is the Epidural Space?

outside the dura mater b/t the dura and the Spinal Column

24

Which vertebrae is the needle inserted through with an epidural?

L2-L5 (L3-L4 mostly)

25

Benefits of Epidural?

Airway remains intact

Only partial motor paralysis

Gastric emptying NOT delayed

Blood loss NOT excessive

26

Nursing actions w/ Epidural:

Why preload with IV fluids?

volume expansion to prevent maternal hypotension

expansion also increases size of epidural space

27

Nursing actions w/ Epidural:

Which position for needle insertion?

modified Sims or upright w/ back curved and legs dangling from bedside

- 'Mad Cat' or 'Angry Shrimp' position

28

Nursing actions w/ Epidural:

After needle insertion, which position should client be placed in?

side lying

- prevents supine hypotension

- helps distribute med evenly

29

Post Epidural Nursing Actions:

Assess maternal VS and FHR and O2 sat

Observe for bladder distention

Protect from injury

Assist woman to change position

Record response to meds

Monitor for adverse reactions

30

Complications from Epidural

Accidental injection into subarachnoid space (High Spinal)

Significant Hypotension

Post dural puncture headache

Infection

31

Why are High Spinals a concern?

can lead to respiratory arrest

32

What should we do if mother has a Hypotensive Episode in response to epidural?

Turn to lateral position or wedge hip

Increase IV rate

O2 by facemask (10-12 L)

Eleveate client's legs (10-20 degrees)

Call Doc

Be prepared to administer vasoconstrictors (Ephedrine)

33

Nursing DX for Hypotensive Episode from Epidural.

Ineffective uteroplacental perfusion r/t maternal hypotension associated w/ epidural block meds

34

When would we expect to see a post dural puncture headache?

2 days after puncture and may continue for weeks

35

What causes relief from Post Dural Puncture Headache?

lie flat for 30 mins or less

36

How do we fix the Post Dural Puncture Headache?

Epidural Blood Path

- the most rapid, beneficial, and reliable relief measure for PDP headache

- woman's blood is injected into the epidural space which creates a clot that patches the tear

- instantaneous pain relief

37

Besides Epidural Blood Patch, what are other treatments for PDP Headache?

Bedreast (lying flat)

Increase CAFFEINE (Mountain Dew and Excedrin)

Fluids (Oral or IV)

38

When is a Prudential Block used?

2nd and 3rd Stages of Labor and for repair of Episiotomy

***epidural block is suitable for all stages of labor and repair of episiotomy

39

Diff b/t Prudential Block and Epidural Block?

Prudintial block just blocks prudential nerve to pernieal area

Epidural block blocks all below L2-L5

40

When would a Prudential Block be administered?

late in 2nd stage of labor

***can also be administered during 3rd stage if episiotomy repair is necessary

41

Benefits of Prudential Block?

Doesn't affect hemodynamic or respiratory functions

Doesn't affect VS

Doesn't affect FHR

42

What is a negative about Prudential Block?

urge to bear down is lessened or lost completely

no relief from UC (only for perineal area)

43

Which type of Anestheisia is used for birth and post delivery repairs and NOT for labor?

Prudential Block

44

What are advantages of a Spinal Block?

rapid pain relief w/o sedative effects

low incidence of adverse effects

45

What would a spinal block be good for?

C-section

46

Disadvantages of Spinal Block

Short duration

Postspinal headache

Increase incidence and degree of hypotension

Urine retention

47

Local Infiltration of Pernieum:

Why would epinephrine be given along w/ a 'caine' med?

to prevent excessive bleeding from episiotomy by constricting blood vessels

48

How is a Local Perineum injection given?

local anestetic (lidocaine) injected into skin and then SQ into region to be anesthetized

49

When would a General Anesthetic be used?

only if regional is contraindicated or if emergency situation develops

50

Fetal adverse reactions to General Anesthesia?

Resp. depression

Hypotonia

Lethargy

51

Examples of Inhaled General Anesthetics?

Nitrous Oxide

Halothane

Fluothane

52

Nursing actions w/ General Anesthesia

Oral antacids to neutralize gastric acid

Tilt the patient to displace uterus and keep IVC from being compressed