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60 Cards in this Set

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CHAPTER TWELVE
(Ignore this card)
First stage pain is
internal visceral pain
Second stage pain is
somatic pain
Third stage pain is
similar to the pain experienced during the first stage
When are sedatives effective
first stage latent phase
When is spinal block effective
second and third stages
When are opioids effective
first stage active phase
When is epidural effective
first stage active phase through third stage
When is pudendal nerve block effective
second and third stages
When is local infiltration pain relief effective
second and third stages
Before administering analgesics, the nurse needs to ensure that labor is progressing; this is done by performing a vaginal examination that reveals a cervical dilation of ___ cm with a fetus that is
4 cm; fetus engaged
Adverse effects of sedatives (3)
neonatal respiratory depression, unsteady maternal ambulation, inhibition of maternal ability to cope with pain
Examples of sedatives
secobarbital (Seconal), Pentobarbital (Nembutal), phenobarbital (Luminal)
Examples of opioid analgesics
meperidine hydrochloride (Demerol), fentanyl (Sublimaze), butorphanol (Stadol), and nalbuphine (Nubain)
Whenich route is recommended when giving opioid analgesics
IV route
which opioid analgesics provide pain relief without causing significant respiratory dpression - i.e., are agonist-antagonists?
Butorphanol (Stadol) and Nalbuphine (Nubain) - remember the ancient Roman stadium
opioid analgesic A. E.
potential neonatal respiratory depression, N/V, sedation, tachycardia, hypotension, decreased FHR variability, allergic reaction
Which drug counteracts the effects of respiratory depression in the newborn resulting from opioids
Naloxone (Narcan)
Which drugs can control anusea and anxiety but do not relieve pain and are used as an adjunct with opioids
phenothiazine medications
Examples of phenothiazine medications
promethazine (Phenergan) and hydroxyzine (Vistaril)
A. E. of phenothiazine medications
dry mouth, sedation - provide ice chips or mouth swabs
What analgesics are used for epidural or spinal regional analgesia
fentanyl (Sublimaze) and sufentanil (Sufenta)
A. E. of epidural and spinal anesthesia
N/V, inhibited bowel and bladder sensations, bradycardia or tachycardia, hypotension, respiratory depression, allergic reaction and pruritus
Examples of regional blocks
pudendal block, epidural block, spinal block, and paracervical nerve block
When is a pudendal block administered
second stage, 10-20 minutes before delivery
What medications may be used for a pudendal block
lidocaine (Xylocaine) or bupivacaine (Marcaine)
A. E. of pudendal block
broad ligament hematoma, compromise of maternal bearing down reflex
An epidural block consists of what medicationss
bupivacaine (Marcaine) along with an analgesic morphine (Duramorph) or fentanyl (Sublimaze)
an epidural block is injected at what level
4th or 5th vertebrae
When is an epidural block administed
active labor, first stage
A. E. of epidural block
maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the bearing down reflex
spinal block is injected into what space
subarachnoid space at 3rd, 4th, or 5th lumbar interspace
the spinal block eliminates all sensations from the level of
nipples to toes
low spinal block may be used for
vaginal birth but not labor
spinal block is administered in the
late second stage or before C-section
When administering general anesthesia, which medications should also be administered
H2 receptor blocker such as ranitidine (Zantac) to decrease gastric acid production; metoclopramide (Reglan) to increase gastric emptying; short-acting barbiturate such as thiopental sodium (Pentothal) to render the client unconscious; succinylcholine chloride (Anectine), a muscle relaxant to facilitate passage of endotracheal tube
CHAPTER THIRTEEN
(Ignore this card)
What should the patient do before Leopold's maneuvers?
empty the bladder
How often should IA be performed on low-risk women during latent phase
every 60 minutes
How often should IA be performed on low-risk women during active phase
every 30 minutes
How often should IA be performed on low-risk women during second stage
every 15 minutes
How often should IA be performed on high-risk women during latent phase
every 30 minutes
How often should IA be performed on high-risk women during active phase
every 15 minutes
How often should IA be performed on high-risk women during second stage
every 5 minutes
IA should be performed following expulsion of an enema, if IA is used
(Please ignore this side of the card)
When using IA, how long should you count the FHR and how long should you listen after a ctx?
FHR for 30-60 seconds; auscultate ctx and followinng 30 seconds
Normal FHR accels should return to baselin in less than
2 minutes
Fetal bradycardia may be caused by
uteroplacental insufficiency, umbilical cord prolapse, maternal hypotension
Fetal tachycardia may be caused by
maternal infection, fetal anemia, fetal heart failure, fetal cardiac dysrhythmias, use of cocaine or meth, maternal dehydration
Decrease or loss of FHR variability may be caused by
meds that depress the CNS, fetal hypoxemia with resulting acidosis, fetal sleep cycle, congenital abnormality
How do you resond to decreased FHR variability
stimulate fetal scalp, position in left-lateral position.
Average IUPC pressure is
50-85 mm Hg
What will happen to pH in fetal hypoxia
will decrease
normal fetal scalp pH is
7.25
fetal scalp blood pH of < 7.20 indicates
fetal distress
FSpO2
fetal oxygen saturation
The infant must be how old to use FSpO2
36 weeks gestation
The cervix must be dilated to at least what to use FSpO2
2 cm
The fetal station must be at least what to use FSpO2
-2
Normal FSpO2 is
30-70%