Epidural Anesthesia and Analgesia
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| What are some indications of Epidurals? | Control of post op pain, chronic pain, or labor pain.
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| Epidurals are effective in controlling acute pain to chest, abdomen, pelvis and lower limbs. (T/F)? | TRUE
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| What are the contraindications? | * Hypovolemia
* Skin infection near insertion site
* Clotting abnormalities or therapeutic anticoagulation
* Abruptio Placentae
* Certain heart conditions
* Patient refusal or unable to give informed consent.
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| What are some steps prior to the procedure? | * Witness consent, perform "timeout"
* Ensure IV infusing, bolus as indicated
* Supplemental oxygen available
* May be asked to give Midazolam I.V. (non-pregnant only)
* VS and prepare to monitor BP and O2 sat.
* Prepare for continuous cardiac monit
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| What does the Nurse care after the procedure include? | * Position pt.
* Monitor Vitals
* Supplemental Oxy PRN
* Safety sign above bed "epidural protocol client"
* Assess dressing, catheter insertion site, and tubing
* Assess pain, muscle weakness, sedation
* Document
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| What is monitored in the ongoing assessments? | Monitor: Ability to void, Pressure and positioning, Analgesic/ anesthetic effects, compliance with mobility limitations if appropriate.
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| What are some Epidural narcotic medications used? | Hydromorphone hydrochloride (dilaudid), Fentanyl (Sublimaze), Morphine sulfate (Duramorph).
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| What are some common Anesthetics used? | Bupivicaine hydrochloride (Marcaine), Ropivicaine hydrochloride (Naropin)
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| What determines the dose? | Patients response.
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| What are some complications of an Epidural? | * Hypotension
* High Spinal anesthesia (affects breathing)
* Migration of catheter into epidural vein
* "Wet Tap" headache
* Infection at insertion site
* Spinal compression dure to formation of epidural hematoma (hard mass + tingling)
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| How do you terminate epidural anesthesia? | * Check labs: if INR >1.5 bleeding risk is increased
* Check tip to verify complete removal
* Monitor VS 15 minutes post-removal.
* Instruct patient to report pain or bleeding at site, urinary retention or headache.
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