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MCN pharm
pain management in labor & delivery
| Question | Answer |
|---|---|
| pharmacologic analgesia- systemic drugs | narcotic analgesics, analgesic potentiators |
| narcotic analgesics actions | primary action on sites in the brain, activating neurons to descend to the spinal cord. |
| common labor narcotic analgesics | stadol(butorphanol tartrate), nubain(nalbuphine hydrochloride), demerol(meperidine hydrochloride), fentanyl(sublimaze) |
| Stadol | butorphanol tartrate, IM or IV 0.5-2mg q4h, peak 30-60min. |
| stadol side effects | sedations, dizziness, fainting, hypotension, hypertension. *life threatening resp. distress* |
| nubain | nalbuphine hydorchloride, SC,IM,IV, 10-20mg q3-6h |
| nubain side effects | sedation, sweaty, clammy skin, N/V *life threatening resp. distress* |
| demerol | meperidine hydrochloride, IV,IM, 2.5-20mg q4h |
| demerol side effects | pruritus, dizziness, sedation, nausea, constipation *life threatening resp. distress, convulsions, cardiac arrest* |
| fentanyl | sublimaze, IV,IM, 50-100mcg q2h |
| fentanyl side effects | bradycardia, hypotension, N/V, resp. distress *life threatening muscle rigidity especially in resp muscles* |
| analgesic potentiators | known as ataractics, decrease anxiety and increase the effectiveness of analgesic when given together. classified as tranquilizers. allows women to receive smaller dose of opioids and decrease unwanted side effects |
| common analgesic potentiators | *zines* promethazine(phenergan), hydroxyzine(vistaril), propriomazine(largon), promazine(sparine) |
| opiate antagonist | naloxone(narcan)- reverse mild resp. distress that follows administration of small doses of opiates. 0.4-2mg, if need readminister q2-3 min |
| types of regional anesthesia and analgesia | epidural, spinal block, puodendal block, epidural-spinal block |
| regional anesthesia | temp loss of sensation produces by injecting agent into direct contact with nervous tissue |
| regional analgesia | pain relief to a body region |
| problems with regional anesthesia | alter impulses to bladder making voiding difficult, interfere with BP and leg movement, slows fetal descent, increased risk of perineal lacerations |
| types of local anesthetic agents | two types- esters and amides |
| ester | novocain, nesacaine, pontocaine. rapidly metabolized, higher incidence of allergic reactions than amides, toxic levels not likely met |
| amide | xylocaine, carbocaine, marcaine. more powerful and longer-acting agents, cross placenta and can affect fetus. |
| xylocaine | associated with neurological toxicity , should not exceed 75mg |
| ropivacaine(naropin) | new generation amide now being used in labor. pain relief similar to other amides. bloackade effect is slightly lower decreasing instrument-assisted births |
| adverse maternal reactions to anesthetic agents | range from mild symptoms to cardiovascular collapse. mild-palpitations, tinnitus, apprehension, confusion, metallic taste. moderate-above+ N/V, convulsions. severe-resp. distress, coma, loss conciousness |
| epidural | anesthetic into epidural space, most frequently used as cont. block to provide analgesia and anesthetic from active labor to episiotomy repair. |
| epidural incidence | most commonly method used during labor, 68% get one, can be given as soon as active labor begins. |
| epidural space | space between dura mater and the ligamentum flavum, is accessed through the lumbar area |
| epidural advantages | relieves discomfort, woman is fully awake and a part of the birth process, less adverse fetal effects, allow rest and regain of strength before pushing, allows different blocking for each labor stage, fetus can descend and rotate,longer postop pain releif |
| epidural disadvantages | maternal hypotension, slow labor progress, less effective pushing efforts, delay bladder sensation |
| epidural nursing care | assess knowledge or epidural, teach, empty bladder prior, assess pain, HR, BP, RR, FHR, for nl parameters, continuous EFM, bolus IV fluids prior to epidural to decrease hypotension |
| continuous epidural infusion benefits | reduces the use of bolus dosages, good analgesia, less N, minimal sedation, decreased anxiety, early mobilization, less risk DVT, ease of administration |
| continuous epidural infusion potential problems | breakthrough pain, sedation, N,V, pruritis and hypotension |
| epidural narcotic analgesia after birth | 24h after birth may inject morphine(duramorph) or fentanyl (sublimaze) into epidural space right after birth. begins working 30-60m |
| spinal block | local anesthetic agent injected into spinal fluid in the spinal canal for c-section and occasionally vaginal birth |
| spinal block advantages | immediate onset, relative ease administration, a need for smaller med volume, maternal compartmentalization of the med. |
| spinal block disadvantages | blockade of sympathetic nervous system, high incidence low BP=alterations in FHT and fetal hypoxia |
| spinal block nursing care | bolus 500-1000mL fluids, assess maternal VS, pain, FHR baselines, reasses after injection of spinal block |
| combined spinal-epidural bloack | CSE, used for cesarean and for labor, when first inserted goes into CSF then needle pulled back into epidural space and left there. faster onset, epidural actived when labor begins |
| pudendal block | transvaginal method, inserted into pudendal nerve, anesthesia for 1st and 2nd stage, birth and episiotomy repair, relives pain in perineal area |
| local infiltration anesthesia | inject anesthetic in intracutaneous, SQ,and IM areas of perineum, generally used at time of birth,prep for an episiotomy and repair of one if done. |
| general anesthesia | may be needed for cesarean birth, combo of inhaled and IV agents |
| maternal comp. of general anesthesia | difficulty in maternal intubation resulting in increased V and aspiration, increased blood loss, difficulty remembering events |
| fetal comp. of general anesthesia | fetal depression, lower 1min apgar scores, not advocated when fetus is high risk |
| nursing care of general anesthesia | document last meal because of decreased gastric motility, administer prophaylactic antacid therapy,place wedge under R hip, preoxygenate, start IV fluids, counsel prior, apply cricoid pressure |
| reason for cricoid pressure | to occlude esophagus and prevent possible aspiration, pressure maintained until endotracheal tube in place |
Created by:
gudknecht
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