Ch 18 Pain Management During Childbirth Part 2


Ch 18 Pain Management for Childbirth Part
2 Opioid pain relief during labor will decrease
the pain level without loss of consciousness or sensation. Some of the common medications used are: meperidine
(Demerol), fentanyl ( Sublimaze), butorphanol (Stadol), and nalbuphine (nubain). These drugs are given in smaller more frequent
doses . They provide quick pain relief but do not last a long time. As labor progresses, these meds tend to not
work as well. They are giving IV and should be given at
the start of a contraction so not as much of the medication will reach the fetus. Resp distress is a side effect that can occur
and it usually affects the infant if the infant is born when the medication is peaking. An opioid antagonists that may be given to
reverse opioid induced respiratory distress is Naloxone (Narcan). If mom is opiate dependent then Naloxone should
not be given as it can induce withdrawal symptoms. In some cases you can see adjunctive drugs
being used to reduce nausea and anxiety. The can also promote rest. Box 18.1 provides examples, doses and notes
on the systemic drugs. General anesthesia is systemic pain control
that causes loss of consciousness. It is not used routinely for cesarean sections
anymore as the medication will go to the infant. It is reserved for women who cannot have spinal
anesthetics or emergency situations. Adverse effects to mom include the risk of
aspiration. Most women during labor are either NPO or
clear liquids so that risk is a little less. Respiratory depression can occur from the
medications. Uterine relaxation is also an adverse effect
which put her at risk for postpartum hemorrhage. Methods to minimize these adverse effects
include keeping NPO, giving meds to raise gastric pH, administer meds to increase gastric
emptying. Respiratory depression in the neonate can
occur since this medication readily reaches them very quickly. The best way to reduce this in the neonate
is the doctors will literally be standing over her with the scalpel in their hands so
the second she is unconscious, they are cutting and quickly getting baby out. It is amazing to see how fast the doctors
can work to get the infant out safely. Nursing care for pain management during labor
includes the assessment phase. Of course assessing pain level is something
that needs to be done. Watching nonverbal as well as verbals. You must also watch the EFM and assess her
contraction pattern and the FHR. Also, what is her preference for pain management
. Has she had anesthesia before and if so, what type and how did she react to it? Pain is the appropriate nursing dx. Remember, many times you may not completely
alleviate all of her pain. (with an epidural, this is more likely than
other measures). So you must determine what is an acceptable
pain level for her. Ask her about that. It is ok if she is trying to not have a medicated
birth for her to complain of pain with contractions as long as she can tolerate the pain. Interventions can include encourage relaxation. How can we do this? Turn lights off, limit visitors, quiet environment,
music of choice. Other interventions include reducing her fear
and anxiety. Do this by keeping her updated and providing
emotional support. Help her with nonpharmacological pain management
if she is going this route. Of course you then have to evaluate to be
sure what you are doing is effective for her . If not, change what you are doing and proceed.

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