PHARMACOLOGIC MANAGEMENT
Learning Outcome <ul><li>Describe the use of systemic drugs to promote pain relief during labor. </li></ul>
Goal of Pharmacologic Pain Relief <ul><li>Goal is to provide maximum pain relief with minimum risk to mother and fetus </l...
What Women Need to Know About Pain-Relief Medications <ul><li>Before receiving medications, the woman should understand th...
Timing of Medication <ul><li>After complete assessment, analgesic agent generally administered when cervical change has oc...
Nursing Management <ul><li>Drugs may cause fetal respiratory depression at birth if given too late in labor </li></ul><ul>...
Learning Outcome <ul><li>Compare the major types of regional analgesia and anesthesia, including area affected, advantages...
Epidural Injection <ul><li>Injection of anesthetic agent into epidural space </li></ul><ul><li>Produces little or no feeli...
Epidural Injection <ul><li>May preload with crystalloid solution bolus </li></ul><ul><li>Woman may need urinary catheteriz...
Technique for Lumbar Epidural Block
Epidural Space
Continuous Epidural Analgesia <ul><li>Provides good analgesia </li></ul><ul><li>Produces less nausea and provides greater ...
Spinal Block <ul><li>Local anesthetic agent injected directly into spinal canal </li></ul><ul><li>Level of anesthesia depe...
Spinal Block <ul><li>Side effects include </li></ul><ul><ul><li>Maternal hypotension, which can lead to fetal hypoxia, req...
Pudendal Block <ul><li>Local anesthesia injected directly into pudendal nerve, which produces anesthesia to lower vagina, ...
Pudendal Block
Local Infiltration <ul><li>Local anesthesia injected into perineum prior to episiotomy </li></ul><ul><li>Provides pain rel...
Local Infiltration
Local Infiltration
Learning Outcome 20-3  <ul><li>Explain the possible complications of regional anesthesia. </li></ul>
Complications <ul><li>Regional anesthesia administered per spinal or epidural route has similar possible complications </l...
Complications <ul><li>Regional anesthesia administered per spinal or epidural route has similar possible complications </l...
Learning Outcome <ul><li>Describe the nursing care management for the laboring woman and her fetus related to general anes...
Nursing Care Related to General Anesthesia <ul><li>Nurse should </li></ul><ul><ul><li>Assess when mother ate or drank last...
Nursing Care Related to General Anesthesia <ul><li>Nurse should </li></ul><ul><ul><li>Provide oxygen prior to start of sur...
Proper Position for Cuffed Endotracheal Tube
Learning Outcome 20-5   <ul><li>Describe the major complications of general anesthesia during labor in nursing care manage...
Major Complications <ul><li>Fetal depression </li></ul><ul><ul><li>If mother receives general anesthesia, infant may have ...
Major Complications <ul><li>Uterine relaxation: Most general anesthetic agents cause some uterine relaxation </li></ul><ul...
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Pharmacologic management 7

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Pharmacologic management 7

  1. 1. PHARMACOLOGIC MANAGEMENT
  2. 2. Learning Outcome <ul><li>Describe the use of systemic drugs to promote pain relief during labor. </li></ul>
  3. 3. Goal of Pharmacologic Pain Relief <ul><li>Goal is to provide maximum pain relief with minimum risk to mother and fetus </li></ul><ul><li>Goal is impacted by following factors </li></ul><ul><ul><li>All systemic drugs used in labor for pain relief cross placental barrier by simple diffusion </li></ul></ul><ul><ul><li>Drug action in body depends on rate at which substance is metabolized by liver </li></ul></ul><ul><ul><li>Fetus has inadequate ability to metabolize analgesic agent </li></ul></ul>
  4. 4. What Women Need to Know About Pain-Relief Medications <ul><li>Before receiving medications, the woman should understand the following </li></ul><ul><ul><li>Type of medication administered </li></ul></ul><ul><ul><li>Route of administration </li></ul></ul><ul><ul><li>Expected effects of medication </li></ul></ul><ul><ul><li>Implications for fetus or newborn </li></ul></ul><ul><ul><li>Safety measures needed (e.g., stay in bed with side rails up) </li></ul></ul>
  5. 5. Timing of Medication <ul><li>After complete assessment, analgesic agent generally administered when cervical change has occurred – pain medication given too early may prolong labor and depress fetus </li></ul>
  6. 6. Nursing Management <ul><li>Drugs may cause fetal respiratory depression at birth if given too late in labor </li></ul><ul><li>Maternal and fetal vital signs must be stable before systemic drugs may be administered </li></ul><ul><li>Assess mother and fetus and evaluate contraction pattern before administering prescribed medications </li></ul>
  7. 7. Learning Outcome <ul><li>Compare the major types of regional analgesia and anesthesia, including area affected, advantages, disadvantages, techniques, and nursing implications. </li></ul>
  8. 8. Epidural Injection <ul><li>Injection of anesthetic agent into epidural space </li></ul><ul><li>Produces little or no feeling to area from uterus downward </li></ul><ul><li>Pushing during second stage of labor may be impaired due to lack of sensation </li></ul><ul><li>Hypotension is most common side effect </li></ul>
  9. 9. Epidural Injection <ul><li>May preload with crystalloid solution bolus </li></ul><ul><li>Woman may need urinary catheterization due to loss of bladder sensation </li></ul><ul><li>Assess sensation motor control and orthostatic blood pressure </li></ul>
  10. 10. Technique for Lumbar Epidural Block
  11. 11. Epidural Space
  12. 12. Continuous Epidural Analgesia <ul><li>Provides good analgesia </li></ul><ul><li>Produces less nausea and provides greater ability to cough </li></ul><ul><li>May produce breakthrough pain, sedation, respiratory depression </li></ul><ul><li>Itching and hypotension are side effects </li></ul>
  13. 13. Spinal Block <ul><li>Local anesthetic agent injected directly into spinal canal </li></ul><ul><li>Level of anesthesia dependent upon level of administration </li></ul><ul><li>May be administered higher for cesarean birth or lower for vaginal birth </li></ul><ul><li>Onset of anesthesia is immediate </li></ul>
  14. 14. Spinal Block <ul><li>Side effects include </li></ul><ul><ul><li>Maternal hypotension, which can lead to fetal hypoxia, requiring frequent blood pressure monitoring for health changes </li></ul></ul><ul><ul><li>Indwelling urinary catheter usually needed due to decreased bladder sensation and tone </li></ul></ul><ul><ul><li>Woman’s legs must be protected from injury for 8 to 12 hours after birth of baby due to decreased movements and sensation </li></ul></ul>
  15. 15. Pudendal Block <ul><li>Local anesthesia injected directly into pudendal nerve, which produces anesthesia to lower vagina, vulva, perineum </li></ul><ul><li>Only produces pain relief at end of labor </li></ul><ul><li>Has no effect on fetus or progress of labor </li></ul><ul><li>May cause hematoma, perforation of rectum, trauma to sciatic nerve </li></ul>
  16. 16. Pudendal Block
  17. 17. Local Infiltration <ul><li>Local anesthesia injected into perineum prior to episiotomy </li></ul><ul><li>Provides pain relief only for episiotomy incision </li></ul><ul><li>There is no effect on maternal or fetal vital signs </li></ul><ul><li>Requires large amounts of local anesthetic agents </li></ul>
  18. 18. Local Infiltration
  19. 19. Local Infiltration
  20. 20. Learning Outcome 20-3 <ul><li>Explain the possible complications of regional anesthesia. </li></ul>
  21. 21. Complications <ul><li>Regional anesthesia administered per spinal or epidural route has similar possible complications </li></ul><ul><ul><li>Maternal hypotension from hypovolemia or effects of anesthesia – treat with bolus of crystalloid IV fluid and notify anesthetist </li></ul></ul><ul><ul><li>Bladder distension </li></ul></ul><ul><ul><li>Inability to push during second stage of labor </li></ul></ul><ul><ul><li>Severe headache with spinal anesthesia </li></ul></ul>
  22. 22. Complications <ul><li>Regional anesthesia administered per spinal or epidural route has similar possible complications </li></ul><ul><ul><li>Elevated temperature with epidural anesthesia </li></ul></ul><ul><ul><li>Possible neurologic damage </li></ul></ul>
  23. 23. Learning Outcome <ul><li>Describe the nursing care management for the laboring woman and her fetus related to general anesthesia. </li></ul>
  24. 24. Nursing Care Related to General Anesthesia <ul><li>Nurse should </li></ul><ul><ul><li>Assess when mother ate or drank last </li></ul></ul><ul><ul><li>Administer prescribed premedication such as antacid </li></ul></ul><ul><ul><li>Place wedge under mother’s right hip to displace uterus and prevent vena cava compression </li></ul></ul>
  25. 25. Nursing Care Related to General Anesthesia <ul><li>Nurse should </li></ul><ul><ul><li>Provide oxygen prior to start of surgery </li></ul></ul><ul><ul><li>Ensure IV access is established </li></ul></ul><ul><ul><li>Assist anesthesiologist by applying cricoid pressure during placement of endotracheal tube </li></ul></ul>
  26. 26. Proper Position for Cuffed Endotracheal Tube
  27. 27. Learning Outcome 20-5 <ul><li>Describe the major complications of general anesthesia during labor in nursing care management of the woman in labor and her fetus. </li></ul>
  28. 28. Major Complications <ul><li>Fetal depression </li></ul><ul><ul><li>If mother receives general anesthesia, infant may have respiratory depression </li></ul></ul><ul><ul><li>Method not advocated when infant is considered high risk </li></ul></ul>
  29. 29. Major Complications <ul><li>Uterine relaxation: Most general anesthetic agents cause some uterine relaxation </li></ul><ul><li>Vomiting </li></ul><ul><li>Aspiration: Agents may also cause vomiting and aspiration </li></ul>

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