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26 Cards in this Set
- Front
- Back
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What does treatments for pain depend on?
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1. client’s tolerance for pain
2. ability to focus on labor 3. ability to remain motivated. |
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methods pof pain relief should include?
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Simplicity
Safety Preservation of fetal homeostasis |
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when giving a paient pain meds what sould you be monitoring?
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: B/P, Pulse, RR, FHR, anesthetic levels,
maternal oxygenation. |
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What does analgesia mean?
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Loss of sensitivity of pain
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what are 4 factors to consider with systemic drugs?
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effects on mother
effects on fetus - all systemic drugs cross placenta by simple diffusion. Fetal liver & kidney function immature, drugs metabolized slowly & effects last longer Affect progress of labor; can slow labor |
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Maternal assessment should include? (2)
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informed concent, VS stable
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Fetal assessment should include? (5)
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FHR 110-160/min with no late/variable decels.
Variability average. Normal fetal movement and accelerations present. Term Fetus No Meconium |
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Labor assessment should include? (5)
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Contraction pattern well established.
Cervix 4-5 cm dilated in primips and 3-4 in multips Progressive descent of presenting part no complications Delivery at least 2-3 hours away. |
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Narcotic Pain Relief (stadol)
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Stronger than Morphine & Demerol. Starts working in < 5 min. Has minimal fetal effects; may cause hallucinations in mom
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Narcotic Pain Relief (Demerol)
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crosses placenta
Half-life is 2.5 hrs. (mother) & 13 hrs. (newborn) Right > administration, FHR variability may decrease Narcan (naloxone) antagonist |
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Narcotic Pain Relief (Nubain)
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does not cause neonatal depression
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Narcotic Pain Relief (fentanyl)
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short-acting potent synthetic opioid.
50-100 mcg IV q 1hr. Used in spinal/epidural |
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What is anesthesia?
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reversible loss of sensation & movement in region of body.
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what is Local aneshesia?
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local anesthetic directly into perineum. Used for minor procedures. No effects on newborn
Lidocane used Relieves pain from episiotomies or when suturing episiotomy and/or lacerations from vaginal deliveries, Rapid onset, Client awake |
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What is a pudental block?
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Relieves pain associated with 2nd (pushing) stage of labor, through vaginal wall and into pudendal nerve in pelvis, numbs area between vagina & anus, Does not relieve pain of contractions.
Works quickly; does not affect baby, Given shortly before delivery, but cannot be used if baby's head is too far down in birth canal, Can prolong 2nd stage labor d/t loss of bearing-down reflex, Provides satisfactory perineal anesthesia for normal delivery, low forceps manipulation, episiotomy |
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What is regional anesthesia?
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- injection of local anesthetic around
nerves of spinal cord to block pain from larger but still limited part of body. |
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About regional anesthesia Epidural?
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Usually uses bupivicane - into epidural space
at 3rd - 4th lumbar interspace. single dose to be repeated or as continuous infusion; common in USA administered > active labor established Good analgesia without CNS depression in mom or fetus; Relieves pain from uterine contractions, vaginal delivery, C/S Epidurals slow labor and may require Pitocin (oxytocin) augmentation. |
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Most common complications with epidurals?
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Maternal hypertension, which can lead to fetal bradycardial and late decels.
Treat hypotension with ephedrine, total spinal block and respiratory parylisis with misplaced caheter, can intefere with moms ability to push, can elevate maternal temp, bladder sensation lost, can interfere with descent and rotation of fetus. |
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Technique for epidural anesthesia?
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get informed concent
monitor bp pulse and FHR 1-2 mins for 15 mins, hydrate w/ ringers lactate, Patient maintains lateral or sitting position, id epidural space, give test dose, keep in position to avoid compression of the catheter, monitor bp for 15 mins, assess angesia level |
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about spinal anesthesia
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Used in C/S. Block level from 8th thoracic dermatome [ xiphoid process/breast. Longer anesthetic effects
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what are anesthetics used in spinal?
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bupivacaine, lidocaine, fentanyl. Duramorph {morphine
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what are the side effects of a spinal?
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urinary retention (foley), pruritis,
nausea, hypotension |
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Complications of spinal
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hypotension- L side, hydrate with 500-1000 cc of RL/NS, ephedrine 5-10 mg IV
Spinal Headache - lie flat for few hours. Vigorous IV hydration. Blood patch – very effective 5 mL of blood without anticoagulunt - injected into epidural space - forms clot & stops leakage VS observed for ~ 2 hrs. |
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General Anesthesia
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total induced unconciosness
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procedure for general anesthesia
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used for emergency delivery
give prophylactic antacid, PRE 02, meds used:Halothane, ketamine, nitrous oxide, thiopental must intubate patient cricoid pressure to prevent aspiration, after intubation meds are given iv+et to maintain anesthesia, |
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whats are the complicaions of general anesthesia?
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Pulmonary aspiration of gastric contents,
failed intubation, aspiration pneumonia, neonatal depression. |
