question

Common sedative for labor is

answer

Barbitol

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Side-effects of barbitol

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Prolonged labor, sedates fetus

question

Causes of pain in the first stage of labor:

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Dilation of the cervix Stretching of the lower uterine segment Pressure on adjacent structures Hypoxia of uterine muscle cells during contractions

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Causes of pain in the second stage of labor:

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Hypoxia of contracting uterine muscle cells Distention of vagina & perineum Pressure on adjacent structures

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Causes of pain in the third stage of labor:

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Uterine contractions Cervical dilation as placenta is expelled

question

A woman's request for pain medication is ____________ __________ for pain relief during labor.

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sufficient justification

question

IV nargotics for pain

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Nubain Stadol Dilaudid

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Ataractics:

answer

Analgesic potentiators used to enhance effects of narcotics

question

Types of ataractics:

answer

Phenergan Largon

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Before administering analgesics you must assess for

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VS, FHR, contraction pattern, pain level, allergies prior to administering

question

Meds. cross placenta ; sedate both mom/baby, common side-effect is

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decrease FHR variability

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Rules on timing of analgesics

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Don't give too close to delivery (after 7cm may sedate baby at birth and depress respiratory response) Don't give too early in labor (may prolong labor in latent phase by reducing contractions with hypotension)

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Nursing implications after administration of analgesics

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Instruct to stay in bed Keep call bell within reach Maintain quiet environment for rest

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What are types of regional anesthesia?

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Lumbar (epidural) Vaginal

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Epidural anesthesia is an

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Injection of anesthetic agent into epidural space to provide pain relief in labor

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Who performs an epidural

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Performed by anesthesiologist, CRNA, or obstetrician

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Where is the epidural needle inserted?

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Lumbar 2-3, just below where the spinal cord ends.

question

Advantages of Epidural

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1. Awake ; part of birth process 2. Less fetal sedation than IV meds 3. Allows for rest/to regain strength 4. Great pain relief from uterus down 5. Often, urge to bear down is preserved 6. Can be placed on continuous infusion pump ; used as a patient controlled analgesia

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Disadvantages of Epidural

answer

1. Complication of hypotension common 2. 2nd stage pushing may be hindered with heavy-dosed epidural 3. Bladder anesthetized-can't feel to void 4. Temporary low back pain/soreness common postpartum 5. Can't ambulate/hinders self-movement

question

Preparation for an epidural includes

answer

1. Informed consent prior to procedure 2. IV fluid bolus prior to placement (LR 500-1000 cc's) to prevent hypotension 3. Frequent VS (baseline & q 5 mins initially) 4. Continuous FHR monitor 5. Position laterally after insertion (wedge under hip to displace uterus) 6. Watch legs-pt can't feel them ; won't know if they are positioned incorrectly, causing injury 7. DON'T FORGET BLADDER (can't feel to void) 8. Encourage REST until pushing started in 2nd stage labor

question

Pudendal anesthesia

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Is given transvaginally to inactivate the pudendal nerve. Relieves pain in the perineum and vulva but it does not stop contractions OR RELEIVE CONTRACTION PAIN.

question

Operative anesthesia includes

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Spinal Block Epidural Block General Anesthesia

question

Spinal block procedure:

answer

1. Local anesthetic injected directly into spinal fluid in spinal canal (subarachnoid space) 2. Anesthetizes from nipple line down 3. Often used for cesarean sections 4. Immediate onset of anesthesia

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Side effects and contraindications of Spinal Blocks:

answer

- hypotension - hx of coagulation problems - Slight risk for spinal hematoma

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Preparation for Spinal Block

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Platelet count

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Spinal Block/Epidural Position

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C shape

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General Anesthesia for induced unconsciousness for surgery.

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1. Only used if absolutely no other choice for anesthesia in C/S 2. Risk of vomiting/aspiration for mom 3. Risk for fetal respiratory depression r/t medications given to mother for anesthesia—baby must be delivered quickly to decrease this risk

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Nursing Interventions with General anesthesia:

answer

1. Explain process - 2. Place wedge under right hip to displace uterus to left 3. Determine last oral intake 4. Give antacid as ordered to reduce acidic content of stomach if aspirates (Bicitra,Tagamet) 5. IV fluids started 6. Pre-oxygenate with 3-5 mins of 100% oxygen 7. May need to apply cricoid pressure for anesthesiologist to prevent aspiration while being intubated

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Why place wedge under right hip to displace uterus to left

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To ensure good venous return by receiving pressure on inferior vena cava

question

Common antacids given just before general anesthesia

answer

Bicitra, Tagamet

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Cricoid pressure technique.

answer

Proper position for fingers in applying cricoid pressure until a cuffed endotracheal tube is placed by the analgesia provider or certified nurse-anesthetist. The cricoid cartilage is depressed 2 to 3 cm posteriorly so that the esophagus is occluded.

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Local anestesia is use:

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1. at time of birth 2. in preparation for episiotomy and/or episiotomy/perineal laceration repair to numb tissues involved

question

Common local anestesia and thoughts:

answer

1. Lidocaine commonly used (Assess allergies 1st) 2. No common adverse effects 3. Additional nursing assessments not necessary

question

A G1P0 client's cervix is 4 cm dilated. She tells the nurse, "I'm in pain, but I'm afraid that medication might harm my baby." Which response is the most therapeutic regarding pain medication during labor?

answer

"Pain medications do affect the baby, but so do pain and stress."

question

A nurse is caring for a laboring client who just received systemic medication for labor pain. Which fetal heart rate pattern would require further action?

answer

Decreased fetal HR and late declerations

question

A nurse is caring for a laboring client who just received an epidural block. What is the major adverse effect for which the nurse should observe?

answer

Hypotension

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Butorphanol tartrate (Stadol) has been ordered for pain for a laboring client. What should the nurse's initial action be prior to administering the medication?

answer

Check for alergies

question

The nurse is administering Benadryl per standing order to treat which commonly occurring side effect during epidural infusion?

answer

Pruritus

question

The nurse is to administer naloxone (Narcan) intravenously. Which medication order would be the most appropriate initial dose to counteract a narcotic-induced maternal respiratory depression?

answer

0.4-2.0 mg

question

Immediately after a cesarean section birth, the anesthesiologist plans to inject a narcotic into the epidural space to provide analgesia for approximately 24 hours. Which opioid should the nurse anticipate that the physician will use?

answer

Duramorph

question

The nurse is caring for four laboring clients. Which client would be the most appropriate candidate for an epidural block? G1P0 dilated 2-3 cm G3P2 dilated 3-4 cm G2P0 dilated 1-2 cm G5P4 dilated 7-8 cm

answer

G3P2 dilated 3-4 cm

question

The nurse is caring for a laboring client who is scheduled for an epidural block. What action prior to the epidural placement would decrease the chance of maternal hypotension?

answer

Infuse an IV bolus of 500-1000 ml of normal saline.

question

The nurse is caring for a client who is scheduled for an induction at 8 a.m. The physician has ordered misoprostol (Cytotec) to be administered before the induction. In planning the client's care, the nurse should give the misoprostol (Cytotec) no later than:

answer

4 am

question

Misoprostol (Cytotec)

answer

Prostaglandin to help induce labor. Also decreases gastric acid production, increases mucus production

question

A nurse is caring for a client with an oxytocin infusion. What is the correct nursing action prior to increasing the oxytocin rate?

answer

Monitor Fetal Heart Tones (FHT)

question

Which client would most likely be induced with a prostaglandin agent? A woman with:

answer

Gestational Diabetes Post date pregnancy

question

Provides long term protection against Hepatitis B virus

answer

Hepatitis B vaccine

question

H2 Blocker used to treat heart burn

answer

Zantac (Ranitidine)

question

German measles vaccine given postpartum if mother has NEGATIVE antibody titer for the virus:

answer

Rubella

question

Narcotic that should not be given in transition:

answer

Nubain (nalbuphine hydrocchloride)

question

Sometimes given postpartum for excessive bleeding. Side effect severe uterine cramping,

answer

Methergine (Methylergonavine maleate)

question

Given to newborn within 12 hours if mother is a Hep B carrier:

answer

HBIG (Hepatitis B Immune Globulin)

question

Contraction and fetal heart rate must be continuously monitored while in use. Carfully titrated by nurse when inducing labor.

answer

Pitocin (oxytocin)

question

Best absorbed if given with food/drink rich in Vitamin C

answer

Iron (Ferrous Sulfate)

question

Taken preconceptually, 0.4 mg daily will prevent neural tube defects.

answer

Folic Acid

question

Immunoglobulin given postpartum to Rh negative women who deliver Rh positive babies?

answer

RhoGAM

question

Prostaglandin used to induce contractions and cause cervical ripening.

answer

Cytotec (misoprostal)

question

Drug of choice for treating Group Beta Strep in labor:

answer

Penicillin G

question

Highly effective non-steroidal anti-inflammatory drug, given p.o., used to treat uterine cramping.

answer

Anaprox (Naproxen Sodium)

question

Not synthesized immediately by newborn. Single dose of 0.5-1mg given IM in vastus lateralis

answer

Vitamine K

question

Needs to be taken with a large glass of water

answer

Colace

question

Antibiotic ointment applied to newborn's eyes within 1 hour of birth to prevent infection from gonorrhea and chlamydia:

answer

Erythromycin

Labor – Anesthesia and Analgesia – Flashcards

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