Pharmacological Methods of Pain Relief Sherpath

Which statement does the nurse use to describe to the patient's partner why opioid analgesics are being administered?

"Opioid analgesics help the laboring woman relax between contractions." The nurse explains that opioid analgesics affect the perception of pain, allowing the laboring woman to relax during contractions.

Which interventions are involved with intrauterine resuscitation during labor?

- Administer oxygen via face mask. - Increase the rate of the intravenous (IV) fluids. - Notify the primary health care provider. - Change maternal position.

Which prescription would the nurse expect to administer to a patient at high risk for maternal hypotension before epidural anesthesia?

- Intravenous fluids

A nurse is managing the administration of nitrous oxide for a patient in labor. The nurse observes for which common side effects of nitrous oxide?

- Nausea - Dizziness - Dysphoria

A nurse is caring for a patient in the first stage of labor who received a combined spinal-epidural (CSE) block with opioid analgesics for pain relief from uterine contractions. The nurse observes for which common side effects of these drugs?

- Nausea - Vomiting - Pruritus

The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. Which explanations most likely explains this occurrence?

- Placental abruption - Vena cava syndrome

A nurse is caring for a patient undergoing an episiotomy repair after birth. Which types of anesthesia does the nurse anticipate?

- Pudendal anesthesia - Local infiltration anesthesia

During an emergency delivery, which maternal adverse effects would a nurse monitor in a patient undergoing general anesthesia?

- Uterine relaxation - Respiratory depression - Maternal aspiration of gastric contents

A patient in active labor requests regional anesthesia for pain management. The nurse knows that the minimum bolus of intravenous (IV) crystalloid fluid to prevent maternal hypotension before regional anesthesia is ________ ml

500 A patient in active labor often presents to the hospital with a fluid volume deficit. A pre-load (bolus) of at least 500 to 1000 mL of an IV crystalloid fluid could help prevent maternal hypotension after regional anesthesia.

Which patient would most likely require general anesthesia during labor and delivery?

A patient refusing regional and local anesthetic methods who needs a cesarean delivery A patient who refuses regional and local anesthetic methods and needs a cesarean delivery does require general anesthesia.

A postpartum patient who had a spinal block for a scheduled cesarean delivery complains of a headache. Which intervention would the nurse anticipate?

Administration of blood patch by the anesthesia provider Administration of a blood patch by an anesthesia professional is a procedure in which the patient's blood is injected into the spinal space, creating a seal over the site where the dural puncture occurred.

Which intervention is most appropriate to increase a laboring woman's maternal cardiac output?

Change maternal position. Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and to avoid the supine position.

While evaluating an external monitor tracing of a woman who just received regional analgesia for pain management, the nurse notes recurrent late decelerations. Which action should the nurse take next?

Change the woman's position. Late decelerations may be caused by maternal supine hypotension syndrome. They may be corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava.

The nurse would question a prescription for spinal anesthesia for a woman with which condition?

Infection at the site of insertion Contraindications and precautions include the woman's refusal, coagulation defects, uncorrected hypovolemia, infection in the area of insertion, systemic infection, allergy, and possibly prior spinal surgery.

Which method of anesthesia in labor is considered safest for the fetus?

Local infiltration Local anesthesia rarely has any adverse effects on either the laboring woman or fetus.

Which assessment is most important to monitor after the administration of epidural anesthesia?

Maternal blood pressure (BP) Maternal hypotension may occur after administration of epidural anesthesia; therefore, the nurse must have an accurate maternal BP reading for several minutes after the epidural is placed.

A patient has received fentanyl, and her respiratory status is rapidly declining. Which medication would the nurse anticipate administering to counteract the effects of this drug?

Naloxone Naloxone counteracts opioid-induced respiratory depression.

A woman received 25 mg of meperidine intravenously 1 hour before delivery. Which drug would the nurse have readily available?

Naloxone Naloxone is the antagonist for opioid medications and should be available for administration to the neonate who exhibits signs of respiratory depression after birth.

A woman is administered fentanyl during labor and is still experiencing significant pain. Which prescription from the health care provider would the nurse anticipate for administration?

Nitrous oxide The nurse anticipates a prescription for nitrous oxide, which can be administered to a woman who is still experiencing pain after the administration of fentanyl.

Match the appropriate type of anesthesia to the patient description.

Patient requires a vaginal laceration repair after delivery - Pudendal block Patient in labor wants pain relief while being awake for the birth - Epidural block Patient with active skin infection requires an emergency cesarean delivery - General anesthesia Patient wants pain relief while being able to move and feel contractions - Combined spinal-epidural anesthesia

Which action would the nurse take to improve placental blood flow immediately after administration of an epidural?

Place a wedge under the woman's right hip Placing a wedge under the right hip improves placental blood flow after a procedure that causes vasodilation.

A patient experiences nausea and vomiting during labor. Which medication might the nurse anticipate administering?

Promethazine The nurse would anticipate promethazine because it relieves the nausea and vomiting that may occur when opioid drugs are given.

A woman in labor is given an opioid analgesic for pain. Which vital sign is a priority for the nurse to monitor in the newborn infant?

Respiratory rate Opioid analgesics can cause respiratory depression, which is more likely to occur in the newborn than in the mother; therefore respiratory rate should be monitored.

A patient arrives at the labor and delivery unit with steady contractions and is 5 cm dilated. On assessment, the fetal heart rate is 200 beats/min, and it is determined that a cesarean delivery should be performed. Which anesthesia method does the nurse anticipate?

Subarachnoid (spinal) block (SAB) The nurse would anticipate an SAB because it is recommended when a quick cesarean birth is necessary and an epidural catheter is not in place.

For which reason would a nurse administer a narcotic to a woman at the beginning of a contraction?

To allow for less medication to be transferred to the fetus To obtain the most beneficial effects of the opioid analgesia during labor and limit transfer to the fetus, the nurse would start the injection of the medication at the beginning of the contraction, when the blood flow to the placenta is normally reduced. When placental blood flow resumes, much of the drug is in maternal tissues (El-Wahab & Fernando, 2014).

The nurse caring for the woman in labor recognizes that maternal hypotension puts the laboring woman at risk for which result?

Uteroplacental insufficiency Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia. This hypoxemia can lead to late decelerations in the fetal heart rate.