chapter 23: Pharmacologic Pain Management- OB

The nurse is providing preoperative teaching to a client for whom a cesarean birth under general anesthesia is scheduled for the next day. Which statement by the client indicates that she requires additional​ information?

"General anesthesia will provide good pain relief after the​ birth."

A cesarean section is ordered for the laboring client with whom the nurse has worked all shift. The client will receive general anesthesia. The nurse knows that potential complications of general anesthesia include which of the​ following?

1)Fetal depression that is directly proportional to the depth and duration of the anesthesia 2)Poor fetal metabolism of​ anesthesia, which inhibits use with preterm infants 3)Uterine relaxation

A laboring client has received an order for epidural anesthesia. In order to prevent the most common complication associated with this​ procedure, what would the nurse expect to​ do?

Hydrate the vascular system with 500dash 1000 mL of intravenous fluids

After administration of an epidural anesthetic to a client in active​ labor, it is most important to assess the mother immediately for which of the​ following?

Hypotension

What is the major adverse side effect of epidural​ anesthesia?

Maternal hypotension

When general anesthesia is necessary for a cesarean​ delivery, what should the nurse be prepared to​ do?

Administer an antacid to the client. Apply cricoid pressure during anesthesia intubation. Preoxygenate for 3-5 minutes before anesthesia. Place a Foley catheter in the​ client's bladder.

Which of the following is a common barbiturate used in​ labor?

Seconal

Prior to receiving lumbar epidural​ anesthesia, the nurse would anticipate placing the laboring client in which​ position?

Sitting on the edge of the bed

A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of​ anesthesia?

Spinal

To reduce possible side effects from a cesarean section under general​ anesthesia, clients are routinely given which type of​ medication?

Antacids

A client had an epidural inserted 2 hours ago. It is functioning​ well, the client is​ stable, and labor is progressing. Which parts of the​ nurse's assessment have the highest​ priority?

Assess blood pressure every hour. Palpate the bladder.

A client received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This client is at increased risk for which problem during the fourth stage of​ labor?

Bladder distention

A client in labor is requesting pain medication. The nurse assesses her labor status​ first, focusing on which of the​ following?

Contraction pattern Amount of cervical dilatation Fetal presenting part

For what common side effects of epidural anesthesia should the nurse​ watch?

Elevated maternal temperature Urinary retention Nausea Local itching

A client dilated to 5 cm has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was​ 120/80 before the procedure and is now​ 80/52. In addition to the bolus of fluids she has been​ given, which medication is preferred to increase her​ BP?

Ephedrine

Which of the following is a major side effect of butorphanol tartrate​ (Stadol)?

Feelings of dysphoria

A cesarean section is ordered for a pregnant client. Because the client is to receive general​ anesthesia, what is the primary danger with which the nurse is​ concerned?

Fetal depression

The primary physician orders a narcotic analgesic for a client in labor. Which situations would lead the nurse to hold the​ medication?

Fetal monitor tracing showing late decelerations Blood pressure​ 80/42

The nurse is caring for a laboring client with thrombocytopenia. During​ labor, it is determined that the client requires a cesarean delivery. The nurse is preparing the client for​ surgery, and should instruct the client that the recommended method of anesthesia is which of the​ following?

General anesthesia

A client has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. The client wants to have a​ medication-free birth. When discussing medication​ alternatives, the nurse should be sure the client understands which of the​ following?

Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

After nalbuphine hydrochloride​ (Nubain) is​ administered, labor progresses​ rapidly, and the baby is born less than 1 hour later. The baby shows signs of respiratory depression. Which medication should the nurse be prepared to administer to the​ newborn?

Naloxone​ (Narcan)

A woman in active labor is given nalbuphine hydrochloride​ (Nubain) 14 mg IV for pain relief. Half an hour​ later, her respirations are at 8 per minute. The physician would likely order which medication for this​ client?

Narcan

Toward the end of the first stage of​ labor, a pudendal block is administered transvaginally. What will the nurse anticipate the​ client's care will​ include?

No additional assessments

A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse​ suggest?

Nonpharmacologic methods of pain relief

The client with a normal pregnancy had an emergency cesarean birth under general anesthesia 2 hours ago. The client now has a respiratory rate of​ 30, pale blue nail​ beds, a pulse rate of​ 110, and a temperature of​ 102.6°F, and is complaining of chest pain. The nurse understands that the client most likely is experiencing which of the​ following?

Pneumonitis

Two hours after an epidural infusion has​ begun, a client complains of itching on her face and neck. What should the nurse​ do?

Recognize that this is a common side​ effect, and follow protocol for administration of Benadryl.

The nurse knows that which of the following are advantages of spinal​ block?

Relative ease of administration Maternal compartmentalization of the drug Immediate onset of anesthesia

Narcotic analgesia is administered to a laboring client at​ 10:00 a.m. The infant is delivered at​ 12:30 p.m. What would the nurse anticipate that the narcotic analgesia could​ do?

Result in neonatal respiratory depression

An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was​ effective?

The client dozes between contractions.

The nurse is assessing a client before administering an analgesic. What are some of the factors the nurse should​ consider?

The client is willing to receive medication after being advised about it. The​ client's vital signs are stable. The client has no known allergies to the medication. The client is aware of the contraindications of the medication.

An anesthesiologist informs the nurse that a client scheduled for a caesarean section will be having general anesthesia with postoperative​ self-controlled analgesia. For which clients would a general anesthesia be​ recommended?

The client who has had a lower back fusion The client who has had surgery for scoliosis

The client at 39​ weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate​ intervention?

The fetal heart rate is 70 prior to making the skin incision.

The nurse is inducing the labor of a client with severe preeclampsia. As labor​ progresses, fetal intolerance of labor develops. The induction medication is turned​ off, and the client is prepared for cesarean birth. Which statement should the nurse include in her preoperative​ teaching?

​"Because of your preeclampsia you are at higher risk for hypotension after an epidural​ anesthesia."

The laboring client brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 cm and​ states, "I​ can't stand this​ anymore! I need something for​ pain! How will an epidural affect my​ baby?" What is the​ nurse's best​ response?

​"It is unlikely that an epidural will decrease your​ baby's heart​ rate."

The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is​ needed?

​"Local anesthetics provide good labor pain​ relief."