NRSE360 EXAM#2 pain management

What do we give patients before an epidural? why?

Before patient received epidural we give bolus of IV fluids because epidural drops BP, so we are preventing hypotension

visceral pain during labor

Uterine Contraction, Cervical Dilation, First stage of labor – lower abdomen, back, legs

somatic pain during labor

• Fetal head pressure, Stretching of pelvic muscles, Perineal tissue stretching

perception of pain (coping +/-)

• Influenced by: Time, Comfort, Anxiety

• Coping scale vs. traditional pain scale

• Positive Coping: Moaning, Rhythmic movements and breathing, Relaxed between contraction

• Negative Coping: Trouble relaxing, Increased agitation, Crying /Screaming

pain interventions: environment

Lighting, Noise, Room temp, Visitors

pain interventions: support person

• Ambulation, Massage, Position changes, Visualization, Heat/cold therapy

pain interventions: meds/ no meds

• Pharmacological interventions

• Nonpharmacological Interventions: yoga, meditation, lamaze, positioning, effleurage, counterpressure, positioning, Bradley method 

Pharmacological interventions: opioid analgesics (onset, guidelines)

•  Rapid onset, Potential effects on fetus, Not appropriate within 1 hour of birth

Pharmacological interventions: opioid meds

•  Stadol: butorphanol

• Nubaine: nalbuphine, IV route

Pharmacological interventions: opioid antagonists

• Naloxone: may be given as needed to rapidly induce opioid induced respiratory depression (Neonatal)

maternal and fetal pharmacological effects

• Fetal effects: Decreased HR variability

• Maternal effects: Nausea, Vomiting,*Respiratory depression

local anesthesia:

• perineal infiltration, pudendal nerve block

regional anesthesia: administration

• Performed by anesthesiologists or nurse anesthetists.

• Used for pain relief during labor and cesarean deliveries.

Spinal or Intrathecal Block:

• Single injection into the subarachnoid space.

• Utilizes opioids like fentanyl and morphine, or local anesthetics like lidocaine and bupivacaine.

• Quick onset, suitable for cesarean births, with a duration of 90-120 minutes.

Epidural Analgesia:

• The gold standard for labor pain relief, affecting the area below T8 to T10.

• Catheter placement in the lumbar epidural space for continuous or intermittent medication delivery.

• Medications include bupivacaine with or without fentanyl, administered via PCA pump as needed.

Epidural: contraindicated

• Certain conditions may preclude epidural use, requiring alternative pain management strategies.