Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
48 Cards in this Set
- Front
- Back
|
An anesthetic agent placed just inside the ligamentum flavum in the epidural space?
|
epidural anesthesia
|
|
|
The chief concern with epidural anesthesia is its tendency to cause ________because of its blocking effect on the sympathetic nerve fibers in the epidural space.
|
hypotension
|
|
|
What is the technique of how Epidural is admin?
|
-position on side, w/ back NOT flexed (b/c of risk of puncturing the dura & giving as a spinal)
-local anesthesic is injected over L3 & L4 -a 3-5" needle is then passed through L3 & L4 into epidural |
|
|
When is an Epidural admin?
|
- active labor and when pt has dilated b/w 3 to 5 cm
(eliminates all sensation from umbilicus to the thighs) |
|
|
What is the technique of how Epidural is admin?
|
-position on side, w/ back NOT flexed (b/c of risk of puncturing the dura & giving as a spinal)
-local anesthesic is injected over L3 & L4 -a 3-5" needle is then passed through L3 & L4 into epidural |
|
|
What does the anesthetist do after they inject a small test dose of local anesthetic solution in the catheter?
|
5 mins later, the woman's legs are inspected for flushing & warmness, evidence that the anesthetic is in the epidural space (peripheral dilatation is beginning). Assess a woman's pulse and b/p at this time.
|
|
|
When is an Epidural admin?
|
- active labor and when pt has dilated b/w 3 to 5 cm
(eliminates all sensation from umbilicus to the thighs) |
|
|
What does the anesthetist do after they inject a small test dose of local anesthetic solution in the catheter?
|
5 mins later, the woman's legs are inspected for flushing & warmness, evidence that the anesthetic is in the epidural space (peripheral dilatation is beginning). Assess a woman's pulse and b/p at this time.
|
|
|
If the anesthetic was accidentally placed in a blood vessel, what will happent to the patient?.
|
toxic symptoms of hypotension, slurred speech, and rapid pulse will be present
|
|
|
Before an additional "top-up" dose is admin, what should the pt be able to do?
|
ask the woman to both write and say out loud a phrase such as “I can do it” three times. If she is unable to do this, question the dose: lack of fine motor coordination and slurred speech indicate a slowly occurring toxic reaction
|
|
|
How long does the effect of the epidural anesthesia last?
|
40 mins to 2 hours
(produces anesthesia up to the level of the umbilicus in to 10 to 15 mins) |
|
|
What are the adverse side effects for an Epidural Anesthesia?
|
-maternal Hypotension
-fetal bradycardia -inability to feel the urge to void -loss of bearing down reflex |
|
|
What happens if the anesthesic gets into the Blood Circulation?
|
manifested as drowsiness, a metallic taste on the tongue, slurred speech, blurred vision, unconsciousness, and seizure leading to cardiac arrest. If such sx occur, it is an emergency situation. The woman needs O2 & an anticonvulsant such as diazepam (Valium) or thiopental (Pentothal) IV, followed by prompt birth of the fetus
|
|
|
If hypotension should occur, what should the nurse do?
|
raising the woman's legs and administering oxygen and additional IV fluid, along with an agent such as ephedrine to elevate blood pressure, may be necessary to stabilize cardiovascular status
|
|
|
The combined use of what 2 drugs can lower the risk for hypotension w/ epidural?
|
1. fentanyl 2. bupivacaine(Marcaine)
-the risk also can be reduced by being sure a woman is well hydrated with 500 to 1000 mL of IV fluid, such as Ringer's lactate, before the anesthetic is given. Ringer's lactate is preferable to a glucose solution, because too much maternal glucose can cause hyperglycemia with rebound hypoglycemia in the newborn. |
|
|
_______ anesthesia is never preferred for childbirth, why?
|
General:
b/c it carries the dangers of hypoxia and possible inhalation of vomitus during administration |
|
|
When is General Anesthesia used?
|
-only in emergency when there is contradication to nerve block analgesia or anesthesia
-produces unconsciousness |
|
|
What adjunct drugs can be given prior to admin of general anesthesia?
|
IV ranitidine (Zantac) or an oral antacid such as cimetidine to be given before general anesthesia is administered, to reduce the level of acid in stomach contents should aspiration occur. Metoclopramide (Reglan) increases gastric emptying and may also be prescribed.
|
|
|
What is the drug of choice to raise b/p?
|
-ephedrine
|
|
|
What is spinal anesthesia?
|
-goes in Subarachnoid space
-use only in emergency b/c it is simpler than epidural -Marcaine(bupivacaine) or ropivacaine(Naropin) is injected using lumbar puncture technique into the subarachnoid space (into the CSF) at the 3rd or 4th lumbar interspace |
|
|
Spinal anesthesia goes to the level of ?
|
T10, Anesthesia up to the umbilicus and including both legs will be achieved.
- |
|
|
Spinal anesthetic agents may be “loaded” or “weighted” with _______ to make them heavier than CSF. This helps prevent ?
|
glucose
them from rising too high in the spinal-canal |
|
|
What are the risk for Spinal anesthesia?
|
-Hypotension from sympathetic blockage in the lower extremities can occur immediately after admin
-This leads to vasodilation and a decrease in central blood pressure. |
|
|
If hypotenstion occurs w/ a Spinal (subarachnoid) anesthesia, what are the nursing interventions?
|
-placental blood perfusion could be compromised.
Turn the woman to her left side to reduce vena cava compression - |
|
|
What position should a woman w/ a spinal NEVER be placed in to help restore b/p?
|
Trendelenburg! This could make the anesthetic rise high in her spinal column, causing uterine or respiratory function to cease.
|
|
|
To guard against hypotension, what IV fluids should be admin?
|
Lactated Ringers
|
|
|
What is a late complication of spinal anesthesia?
|
postpartal dural puncture headache (PDPH) or “spinal headache.”
|
|
|
Why does a postpartal dural puncture headache (PDPH) or “spinal headache occur?
|
-continuous leakage of CSF from the needle insertion site &
-possibly from the irritation of a small amount of air that enters at the injection site |
|
|
If a HA does occur w/ a spinal anesthesia, how can it be relieved?
|
having the woman lie flat & admin an analgesic. Some women find a cold cloth applied to the forehead helpful.
|
|
|
If a spinal headache is incapacitating, it can be treated with?
|
a blood patch technique. For this, 10 mL of blood is withdrawn from an accessible vein and then immediately injected into the epidural space over the spinal injection site. The injected blood clots and seals off any further leakage of CSF.
|
|
|
What is the action of Narcan?
|
Naloxone hydrochloride is a narcotic antagonist that counteracts the effect of narcotic analgesics. It is used to counteract newborn respiratory depression when a mother has received a narcotic analgesic during labor.
|
|
|
What is the action of Narcan?
|
Naloxone hydrochloride is a narcotic antagonist that counteracts the effect of narcotic analgesics. It is used to counteract newborn respiratory depression when a mother has received a narcotic analgesic during labor.
|
|
|
What is the Dosgae for Narcan?
|
0.01 mg/kg, administered either IV via umbilical vein, SC, or IM; repeated at 2- to 3-minute intervals until response is obtained.
|
|
|
What are the side effects to Narcan?
|
Hypotension, hypertension, tachycardia, diaphoresis, tremulousness
|
|
|
What are the side effects to Narcan?
|
Hypotension, hypertension, tachycardia, diaphoresis, tremulousness
|
|
|
because the fetal liver takes 2 to 3 hours to activate the drug(meperidine) into the fetal system, the effect will not be registered in the fetus, for how many hours after maternal admin?
|
for 2 to 3 hours after maternal admin. For this reason, meperidine is given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.
|
|
|
Because meperidine crosses the placenta, it can cause _______ _________ in a fetus. The drug crosses the placenta minutes after either IV or IM administration to the woman
|
respiratory depression
|
|
|
It may be puzzling to see a sleepy baby delivered to a woman who was given meperidine 2 hours before birth and an alert baby delivered to a woman who had received meperidine within 1 hour of birth
|
In the second instance, the peak action or peak effect has not yet occurred in the infant. This newborn needs careful assessment for the next 4 hours until the drug reaches its peak
|
|
|
because the fetal liver takes 2 to 3 hours to activate the drug(meperidine) into the fetal system, the effect will not be registered in the fetus, for how many hours after maternal admin?
|
for 2 to 3 hours after maternal admin. For this reason, meperidine is given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.
|
|
|
Because meperidine crosses the placenta, it can cause _______ _________ in a fetus. The drug crosses the placenta minutes after either IV or IM administration to the woman
|
respiratory depression
|
|
|
It may be puzzling to see a sleepy baby delivered to a woman who was given meperidine 2 hours before birth and an alert baby delivered to a woman who had received meperidine within 1 hour of birth
|
In the second instance, the peak action or peak effect has not yet occurred in the infant. This newborn needs careful assessment for the next 4 hours until the drug reaches its peak
|
|
|
If severe infant respiratory depression is anticipated, when can Narcan be given?
|
naloxone can be given to a woman just before birth. It readily crosses the placenta and, because it interferes with or competes for narcotic binding sites, may increase the chance for spontaneous respiratory activity in the newborn.
|
|
|
Carefully observe an infant who receives naloxone in the immediate postpartum period, why?
|
b/c the infant's respirations may become severely depressed again when the drug's effect wears off
|
|
|
one who is seemingly unaffected by pain?
|
Stoic
|
|
|
General anesthesia is not administered for an _________ labor, why?
|
uncomplicated
-because it has risks for both the mother and the infant, but may still be used in an emergency. |
|
|
If a narcotic analgesic is used, _______ must be available for possible newborn resuscitation
|
naloxone (Narcan)
|
|
|
During regional or general anesthesia administration, if a woman must lie supine, she should have a wedge positioned under her right buttock to help prevent ?
|
supine hypotension syndrome
- If hypotension should occur after epidural anesthesia administration, elevating a woman's legs is an emergency measure to help relieve hypotension |
|
|
Women may lose their ability to use controlled _______after systemic narcotic administration, why? because of a “lightheaded” feeling. They may need additional support during this time to be able to continue with a breathing technique until the analgesic agent begins to have an effect.
|
breathing
b/c of a “lightheaded” feeling. may need additional support during this time to be able to cont. w/ a breathing tech until the analgesic agent begins to have an effect. |
