NURS 351 Exam 2 Study Guide – Nevada State College

NURS 351 Exam 2 Study Guide – Nevada State College Study guide exam 2 Ch 17 Maximizing comfort • General anesthesia – rarely used for uncomplicated vaginal birth o Nitrous Oxide: laughing gas for labor ¬ Nitrous ...

NURS 351 Exam 2 Study Guide – Nevada State College Study guide exam 2 Ch 17 Maximizing comfort • General anesthesia – rarely used for uncomplicated vaginal birth o Nitrous Oxide: laughing gas for labor ¬ Nitrous oxide mixed with oxygen provides analgesia during the first and second stages of labor ¬ Self-administered by laboring woman ¬ Used in any stage of labor ¬ Full effect in 30-60 seconds ¬ Effect: pain relief, euphoria, less anxiety ¬ Side effect: nausea, vomiting, poor recall of labor o Anesthesia: General anesthesia 12 (loss of consciousness) ¬ Rarely used for uncomplicated vaginal birth ¬ The woman should be premedicated with (clear) oral antacid to neutralize the acidic contents of the stomach. ¬ Because of this risk for neonatal narcosis, it is critical that the baby be delivered as soon as possible after induction of general anesthesia o Regional analgesia and anesthesia and local 13 ¬ Epidural: currently the most effective pharmacologic pain relief method for labor ¬ Combined spinal-epidural (CSE) ¬ Walking epidural – lighter version of epidural ¬ Spinal ¬ PCEA ¬ Pudendal Block • Epidural/spinal anesthesia and associated complications – everything o Regional analgesia and anesthesia: contraindications ¬ History of spinal surgery/ abnormalities ¬ Active or anticipated serious maternal hemorrhage ¬ Maternal hypotension ¬ Maternal coagulopathy ¬ Infection at the injection site ¬ Thrombocytopenia ¬ Increased intracranial pressure ¬ Maternal refusal or inability to cooperate ¬ Some types of maternal cardiac conditions o Contraindicated for the woman who is receiving anticoagulation therapy o Side Effects/complications of regional anesthesia ¬ Hypotension ¬ Changes in FHR ¬ Nausea and Vomiting ¬ Pruritis ¬ Urinary retention, Maternal temperature ¬ Postdural puncture headache ¬ High spinal ¬ Intravascular injection ¬ Epidural hematoma • Nonpharmacological pain management o Application of heat and cold o Massage o Birthing Balls o Hydrotherapy o Acupressure and acupuncture o Frequent position change o Aromatherapy o Music o Hypnosis • All about pain; anxiety and pain Definition of pain ♣ Pain tolerance refer to the level of pain a laboring woman is willing to endure o First stage of labor (visceral pain) o Second stage (visceral +somatic pain) ♣ Somatic pain - intence, sharp, burning, and well localized o Third stage (similar to the first stage) Factors influencing pain response o Anxiety and fear o Culture o Previous experience o Support system o Environment Non-pharmacological management of pain o Gate-control theory – pain relieve techniques to distract from pain (massage, music, stroking, ect..) o P.385 – BOX 17-2 o Breathing techniques – p387, BOX 17-3 Pharmacologic pain management (p392 BOX 17-4) o Sedatives: relieve anxiety, depress CNS, induce sleep ¬ Can be given to a woman experiencing a prolonged latent phase of labor when there is a need to lessen the intensity of the contractions ¬ They can also be given to augment analgesics and reduce nausea when an opioid is used o Barbiturates (Secobarbital) – side effects- respiratory and vasomotor depression ¬ Should be avoided if birth is anticipated within 12 to 24h o Benzodiazepines (lorazepam - Ativan, diazepam - Valium) enhance pain relief and reduce nausea and vomiting when administered with opioids ¬ Major side effects (drowsiness, hypotension; diazepam hurts newborn thermoregulation) o Analgesia (p 392 BOX 17-4) is partial or full relief of painful sensation using medications that decrease or alter the perception of pain (alleviation of pain) o Anesthesia: Partial or complete loss of sensation with or without loss of consciousness (removing sensation) ¬ The type of analgesic or anesthetic chosen is determined in part by the stage of labor of the woman and by the method o Meperidine(Demerol) and Fentanyl (Sublimaze) stimulate opioid receptors, mu and kappa o Morphine - affinity for mu receptors o Morphine – lesser risk for neonatal sedation compare to Demerol o Stadol, Nubain – affinity for kappa and sigma receptors, lesser Respiratory Depression Side effects of narcotics: ♣ Maternal/fetal sedation ♣ Maternal/fetal respiratory depression ♣ Maternal: NV, dizziness, urinary retention ♣ Fetal: Decrease in FHR variability ♣ Newborn: Decreased muscle tone and ineffective sucking reflex with difficulty initiating breathing ♣ Naloxone (Narcan) – administered to reverse the depressant effect of the opioids Ch 18 Fetal assessment • EFM equipment; placement o Intermittent auscultation (IA) ¬ Listening to fetal heart sounds at periodic intervals to assess FHR ♣ Pinard fetoscope (p411) ♣ Doppler ultrasound ♣ Ultrasound stetoscope ¬ Easy to use, inexpensive, less invasive than EFM ¬ Difficult to perform on women who are obese ¬ Does not provide a permanent record o Electronic fetal monitoring o External monitoring (p414) ¬ Ultrasound transducer - reflects high-frequency sound waves off a moving interface: the fetal heart and valves ¬ Tocotransducer – measures UA transabdominally. Placed over the fundus above umbilicus and held securely in place using an elastic belt • Everything about Internal monitors o Fetal Scalp Electrode (FSE): internal monitoring of the FHR o Intrauterine pressure catheter (IUPC): monitoring uterine contractions • Fetal heart abnormal rates: tachycardia, bradycardia ϖ Tachycardia: >160 beats/min  10 minutes or more Causes: ¬ Maternal infection, chorioamnionitis ¬ Fetal anemia ¬ Fetal cardiac dysrhythmias ¬ Maternal use of cocaine/meth ¬ Maternal dehydration ¬ Fetal infection ¬ Maternal hyperthyroidism ϖ Bradycardia: <110 beats/min  10 minutes or more Causes ¬ Uteroplacental insufficiency ¬ Umbilical cord prolapse ¬ Maternal hypotension ¬ Prolong umbilical cord compression ¬ Fetal congenital heart block ¬ Anesthetic medications