Pain Management continued & EFM II begins ( E3)

Reaccreditation Visit Preparation

  • The nursing program has been preparing for reaccreditation for ten years, conducted by CCNE visitors.
  • The visitors will observe the class for about fifteen minutes on Wednesday.
  • Importance of accreditation:
    • Determines if the nursing school meets its stated educational goals.
    • Only graduates from accredited schools can take the licensing exam to become registered nurses.
    • Loyola’s outstanding record has placed it on a ten-year reaccreditation cycle instead of the standard five-year.
  • Accreditations reflect the hard work of faculty and staff to meet educational standards.

Class Adjustments Due to Meetings

  • Due to ongoing meetings for reaccreditation, adjustments are made to class schedules and deadlines:
    • The post-exam wrapper submission deadline is extended by one week, now due next Sunday night.
    • There will be additional sign-up blocks for Zoom meetings for students.
    • There will also be group office hours to accommodate student feedback and questions.

Pain Management in Nursing

  • Reminder of pain management categories:
    • Pain management in elderly patients.
    • Unmedicated pain management.
    • Systemic analgesia.
    • Regional anesthesia.

Regional Anesthesia Overview

  • Definition: Regional anesthesia involves blocking pain sensation in a specific area of the body.
  • Types of regional anesthesia discussed:
    • Epidural anesthesia
    • Spinal anesthesia
    • Local anesthetic

Epidural and Spinal Anesthesia

  • Epidural Contraindications:
    • Local or systemic infection: Risk of introducing infection into the body.
    • Important anatomical context: The injection goes through layers, risking transport of infection if a needle is inserted into an infected area.
    • Coagulation disorders:
    • Low platelet count (<100,000): Risk of hematoma formation near the spinal cord.
    • Significant spinal abnormalities or prior back surgery.
  • Major Side Effects of Epidural and Spinal Anesthesia:
    • Hypotension: Can lead to insufficient blood flow to the fetus, particularly if the patient is hypovolemic.
    • Difficulty in labor: Patients must be able to sit still for the epidural to be placed.

Mechanism of Action

  • Epidural and spinal anesthesia administered by trained professionals (anesthesiologist or CRNA).
  • Initial dose followed by a catheter that delivers medication continuously.
  • Patient-controlled epidural anesthesia (PCEA): Allows patients to request additional doses within safe limits.
  • Safety assurance: Patients are informed they cannot overdose, as the system has lockout periods.

Pain Management Considerations

  • Pain management is a complex and ethical aspect of nursing:
    • Pain indicates there is something wrong. Understanding and managing pain is crucial for patient care.
    • Emphasis on relieving patient pain without compromising safety.
  • Advantages of Epidural:
    • No sedation.
    • Patients have some control over their pain management.
    • Does not cross the placenta, hence no impact on the fetus.
  • Disadvantages of Epidural:
    • Risk of transient hypothesized hypotension leading to fetal bradycardia.
    • Time to complete pain relief may take up to 30 minutes.
    • Potential for difficulty in bladder sensation post-epidural.

Detailed Anatomy and Physiology

  • Positioning:
    • Positioning of patients during epidural is critical to avoid complications such as hypotension.
  • Monitoring Post-Epidural:
    • Importance of continuous electronic fetal monitoring.
    • Assessing fluid intake: Preloading IV fluids are essential before and after administering epidural anesthesia.

Types of Decelerations in Fetal Heart Rate Monitoring

  • Variable Decelerations:
    • Characterized by rapid descent and return in fetal heart rate.
    • Typically due to umbilical cord compression.
    • Shapes: U-shape, V-shape, or W-shape.
  • Early Decelerations:
    • Gradual decrease that coincides with contractions.
    • Caused by fetal head compression; perceived as benign and indicative of the fetus being close to delivery.
  • Late Decelerations:
    • Occurs after the contraction peaks and returns after the contraction.
    • Indicates fetal hypoxia and necessitates immediate intervention to prevent complications.
  • Prolonged Decelerations:
    • Lasts longer than 2 minutes but less than 10.

Definitions and Distinctions

  • Deceleration: A symmetrical gradual decrease in fetal heart rate, returning to baseline.
  • Importance of recognizing early, late, and variable decelerations—misidentification leads to critical errors in management.
  • Monitor vital signs: Maintain awareness of maternal health conditions that could affect fetal circulation such as low blood pressure or uterine compression issues.
  • Accurate charting and documentation of fetal heart tracing is crucial in labor management.

Closing

  • Prepared to continue discussing fetal heart monitoring, focusing on appropriate interventions and management strategies in response to various decelerations.
  • Emphasize all nursing staff's responsibility to ensure safe childbirth experiences for mothers and infants.
  • Encourage active student participation and preparedness for upcoming topics, examinations, and clinical applications during the course.