Pharmacologic Pain Management During Labor - PowerPoint PPT Presentation

Loading...

PPT – Pharmacologic Pain Management During Labor PowerPoint presentation | free to download - id: 700260-OTA5Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Pharmacologic Pain Management During Labor

Description:

Title: Labor Pain and Coping Mechanisms Author: Brian&Karina Last modified by: Brian&Karina Created Date: 3/25/2009 2:09:20 AM Document presentation format – PowerPoint PPT presentation

Number of Views:192
Avg rating:3.0/5.0
Slides: 44
Provided by: Bria4183
Learn more at: http://swpec.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Pharmacologic Pain Management During Labor


1
Pharmacologic Pain ManagementDuring Labor
  • By Karina Schaub, RNC, MN

2
Objectives
  • Identify several ways to help patients cope with
    labor pain
  • Identify which method(s) of pain relief is
    appropriate for the different phases of labor
  • Describe the appropriate nursing care before,
    during, and after selected pain relief methods

3
Physiologic Responses to Pain
  • Release of Catecholamines
  • BP
  • HR
  • RR
  • Tension

4
2 Kinds of Pain
  • Visceral
  • (Internal)
  • 1st stage of labor
  • Lactic acid accumulation
  • Cervical and lower uterine segment stretching
  • Tension on ovaries and fallopian tubes
  • Pressure on bony pelvis.
  • Somatic
  • (Soma-body surface)
  • 2nd stage of labor
  • Actual stretching of tissues
  • Powerful urge to push

5
Pharmacologic Coping
  • Narcotics
  • PO
  • IM
  • IV
  • Epidural
  • Walking Epidural
  • Intrathecal
  • Pudendal

6
Assess Patient for Stage of Labor
  • 1st Stage of Labor
  • Early Labor
  • Active Labor
  • Transition
  • 2nd Stage of Labor
  • Impending Delivery

7
Pregnancy Risk Categories
  • Category A
  • Studies in pregnant women have not shown and
    increased risk to fetus
  • Category B
  • Animal studies show no risk to fetus but there
    are no adequate studies of pregnant women
  • OR
  • Animal studies have shown an adverse effect to
    fetus but studies of pregnant women have shown no
    risk to fetus
  • Category C
  • Animal studies have shown an adverse effect to
    fetus but there are no adequate studies of
    pregnant women
  • OR
  • There are no animal studies or pregnant women
    studies done

8
Pregnancy Risk Categories contd
  • Category D
  • Studies in pregnant women have shown a risk to
    fetus but the benefits of the drug may outweigh
    the risks
  • Category X
  • Studies in pregnant women and animals have shown
    evidence of fetal abnormalities
  • The use of this drug in contraindicated in
    pregnancy

9
Outpatient Pain Medications
Drug Dosage Onset Duration
Darvocet Tablets PO 15-60 min 4-6 hrs
Demerol 50-100 mg PO, IM PO 15 min IM 10-15 min 2-4 hrs
Fentanyl 50-100 mcg IM 7-15 min 1-2 hrs
Morphine 30 mg PO 4-10 mg IM PO Unknown IM 10-30 min 4-5 hrs
Vicodin 1-2 tabs PO 10-30 min 4-6 hrs
10
Outpatient Medications
Drug Action Dosage Onset Duration
Ambien Sedative 5-10 MG PO Rapid 6-8 hrs
Phenergan Sedative, Antiemetic, Antihistamine 12.5-25 MG PO, IM 20 min 4-12 hrs
Vistaril Sedative, Antiemetic, Antihistamine, Antianxiety 25-100 mg PO, IM 15-30 min 4-6 hrs
11
Inpatient Pain Medication
Drug Dosage Onset Duration
Fentanyl 25-100 mcg IV 1-2 min 30-60 min
Morphine 2-5 mg IV lt1 min 4-5 hrs
Nubain 10-20 mg IV 2-3 min 3-6 hrs
Stadol 1 mg IV Minutes 2-4 hrs
12
Effects of Medication on Patient
  • Alleviate some pain but not all
  • Causes drowsiness
  • Causes a lightheaded feeling
  • Will help her to cope with labor

13
Effect of Medication on Fetus
  • Decreased Variability
  • Depressed Respiratory System
  • How long will it last?
  • Look at peak of medication administered
  • Look at duration of medication administered
  • Consider O2

14
Pain Medication Nursing Considerations
  • Monitor before after administration
  • Fetal Wellbeing
  • V/S
  • BRP
  • Ambulation

15
Epidural(Regional Anesthesia)
  • Preparation
  • Provider Order
  • Pt Consent
  • Baseline v/s
  • IV Bolus
  • Alka Seltzer Gold or Bicitra
  • Epidural Cart
  • Call Anesthesiologist

16
Special Considerations
  • Allergies
  • Unstable v/s
  • Positive Blood Culture
  • PIH labs (Platelets, PT/PTT/INR)
  • Coagulation Disorders
  • Fetal Distress

17
Epidural Placement
  • Pitocin On or Off ?
  • Positioning

18
Epidural Placement
19
(No Transcript)
20
Epidural Placement
21
Epidural
  • Procedure
  • Betadine solution to clean area
  • Local Anesthetic to numb area
  • Placement of epidural between L2 L5
  • Test dose

22
Epidural Placement
  • Test dose
  • HR monitor
  • Drug used is Lidocaine Epinephrine
  • Administered between contractions
  • If in Spinal area
  • Legs suddenly go numb
  • If in Blood Vessel
  • Sudden increase in HR
  • Pt experiences palpitations
  • Ringing in ears
  • Metal taste in mouth

23
Epidural
  • Initial injection after test dose and continuous
    infusion of
  • Local Anesthetic (Bupivicaine or Ropivicaine)
  • Narcotic (Fentanyl)
  • May have option of PCEA for bolus of medicine

24
Epidural Care
  • Supine Position with Tilt
  • Monitor B/P, HR, RR Closely
  • Q 3-5 minutes per Anesthesiologist
  • Per hospital protocol after stable
  • Continuous Fetal Monitoring
  • Dermatome level T6 or below

25
Dermatome Levels
26
Epidural Emergency 1
  • Pts B/P drops
  • Is pt dizzy or lightheaded?
  • IV open for bolus
  • HOB down with pt tilted
  • O2
  • Inform Anesthesiologist
  • Fetal Heart Tones
  • lt90 SBP compromises baby

27
Epidural Emergency 2
  • Drop in Fetal Heart Tones
  • Drop in maternal B/P?
  • Baby may show signs before mom does
  • Pt position change
  • IV open for bolus
  • Oxygen
  • Inform Anesthesiologist

28
Epidural Emergency 3
  • Pt c/o Shortness of Breath
  • Positioning in bed
  • O2 Saturations
  • Check Dermatome Level
  • If continues, report to Anesthesiologist

29
Epidural Emergency 4
  • You walk in and assess your patient to find
  • RR lt 10 / min
  • Shallow RR
  • Decreased LOC

STOP epidural infusion, O2, call
anesthesiologist, give Narcan per protocol,
monitor O2 sats
30
Epidural Patient Teaching
Onset of pain relief PCEA Button Pain on one side
of the body Position Changes
31
Epidural Patient Teaching contd
  • Bedrest
  • Continuous Monitoring
  • Alteration in Elimination
  • Itching
  • Breathing

32
Walking Epidural
  • Injection of ½ the concentration of epidural
    medication
  • Local Anesthetic
  • Narcotic
  • Pt can ambulate
  • Injected into same space as Epidural
  • Same needle size
  • Continuous gtt of low dose local anesthetic
    narcotic

33
Removing Epidural
  • Discontinue gtt after delivery of baby
  • Removing the catheter
  • Is pt having a tubal ligation?
  • Positioning
  • Look for black tip

34
Intrathecal
  • Single injection
  • Injection into Subarachnoid Space (Dura)
  • Same area spinals are given
  • Same needle size as spinals
  • Medications injected are
  • Local Anesthetic (Marcaine)
  • Narcotic (Fentanyl)
  • Wears off in 2 hrs

35
Spinal Headache
  • Occurs most often 24 hrs post procedure
  • Occurs most often with Epidural as opposed to
    Spinal or Intrathecal
  • HA is worse sitting up
  • Treatment is a blood patch
  • Anesthesiologist performs
  • 10ml of blood injected into epidural space
  • Pt stays supine for 10 minutes
  • Immediate HA relief

36
Pudendal
37
Pudendal
  • Used shortly before delivery
  • Single injection of Lidocaine
  • Blocks pain in vaginal and anal area (Somatic
    pain)
  • Does not relieve contraction pain
  • Takes effect instantly
  • Lasts about an hour
  • May affect breastfeeding immediately after birth

38
Perineal Nerves
39
Conclusion
  • Follow the recommended guidelines for monitoring
    the patient and fetus when administering
    medications
  • Keep patient informed of normal side effects of
    medications they will be receiving
  • Report any abnormal side effects to the
    appropriate provider

40

41
Questions
  • ?

42
References
  • Adam. Positions for an Epidural. Online Image
    Retrieved June 25, 2010 from http//www.pennmedici
    ne.org/health_info/pregnancy/graphics/images/en/19
    169.jpg .
  • American Pregnancy Association (2007). Pudendal
    Block. Retrieved June 18, 2009 from
    http//www.americanpregnancy.org/labornbirth/puden
    dalblock.htm.
  • American Society of PeriAnesthesia Nurses (1992).
    Standards of Post Anesthesia Nursing Practice.
  • Association of Womens Health, Obstetric and
    Neonatal Nurses. (2001). Evidence-Based Clinical
    Practice Guidelines, Nursing Care of the Woman
    Receiving Regional Analgesia/Anesthesia in Labor.
  • Barnett, A. Ochroch, E. (2003). Epidural
    Analgesia Management and Outcomes. Annals of
    Long-term Care, 11(11).
  • Dermatomes. Online Image Retrieved June 25,
    2009 from http//www.anatomyatlases.org/AnatomicVa
    riants/NervousSystem/Images/63H.jpg.
  • Gabbe, S., Niebyl, J., Simpson, J. (1997).
    Obstetrics- Normal and Problem Pregnancies.

43
References contd
  • Gambling, D. (1996). Epidural Analgesia. Journal
    of Obstetric, Gynecologic, and Neonatal Nursing,
    25(8), 650.
  • Gambling, D. (2000). Fourth Annual Perinatal
    Conference. Controversies in Obstetric
    Anesthesia.
  • Nagoette, M. (1999). How Does An Epidural Affect
    the Cesarean Section Rate? Contemporary OB/GYN,
    24-36.
  • Olds, S., London M., Ladewig, P. (1988).
    Maternal Newborn Nursing - A Family Centered
    Approach.
  • Perineal Nerves. Online Image Retrieved June
    21, 2009 from http//www.atlasofpelvicsurgery.com/
    1VulvaandIntroitus/9alcoholinjection/chap1sec9imag
    es/chap1sec9image1.jpg.
  • Pudendal Block. Online Image Retrieved June 25,
    2010 from http//hetv.org/resources/reproductive-h
    ealth/impac/Images_P/fig79vaginal.gif
  • Wild, L. Coyne C. (1992). The Basics and
    Beyond Epidural Analgesia. American Journal of
    Nursing.
About PowerShow.com