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18 Cards in this Set
- Front
- Back
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What causes uterine ischemia during labor?
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Smooth muscle of the uterus contracts down and cuts off blood supply
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Physiologic response to pain
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Catecholamine release, increased metabolic demand, O2 consumption, CO, BP, catabolism, fatigue, and lactic acid production, decreased uterine blood flow, endorphine release
NOTE: a healthy pt can handle these changes, be aware of pathophys that could change a pts tolerance |
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What type of breathing for active phase of labor?
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Modified paced breathing
Patterned paced breathing |
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What type of breathing for transition?
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Patterned paced breathing
Panting |
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What are the maternal effects of parenteral narcotics?
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Sedation, decreased GI motility, N&V, need for additional analgesia in labor and delivery
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Do narcotics completely take the pain away?
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No, but they will relax the pt.
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Are OB narcotics long or short acting, and long or short half-life? Why?
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Short acting and short half life to avoid treating respiratory depression in neonate
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Types of regional blocks
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Local infiltration anesthesia
Pudental block Paracervical block Spinal block |
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What would local infiltration anesthesia be used for?
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This is a type of regional block used for episiotomy and laceration repair. ex: lidocaine 1%
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If paracervical blocks were still in use, when would they be used and for what type of pain?
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1st stage of labor, to relieve pain from cervical dilation. Not used due to fetal bradycardia
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What is the difference between a spinal block and epidural?
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Spinal block is placed into the subarachnoid space and will mix with the CSF. Epidural goes into the epidural space and you do not want it to hit the spinal fluid
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If the client needs an emergency c-section and is not a candidate for general anesthesia, what will be used?
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Spinal block
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Contraindications for lumbar epidural
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Patient refusal
Infection Hemorrhage Neurologic disease Coagulation disorders Fetal distress Anatomic or technical difficulty Significant hypotension Uncorrected hypovolemia |
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What are complications of lumbar epidural?
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Failed or incomplete block
Unilateral block *Maternal hypotension* Intravascular injection or local anesthetic "Wet tap" Accidental subarachnoid injection of local anesthetic (causes respiratory depression) |
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How much fluid should a client receive as a bolus before an epidural?
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At least 500cc, but usually 1000cc
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Epidural narcotics
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**Many opiate binding receptors in epidural space and in spinal cord so this is very effective pain management**
Results in analgesia without as much numbing and women are able to push better b/c can feel perineum ex: duramorph in epidural |
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What is ideal for pain management post partum c-section?
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Epidural narcotics. Pt walks sooner, bowel function returns more quickly, better pain control, one injection lasts about 8 hrs. Side effect = itching, watch for respiratory depression
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What general anesthesia risk is increased during pregnancy? How can you avoid it?
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Aspiration
Avoid with nonparticulate antacid, rapid sequence induction |
