OB Quiz #2 COPY.docx - Study guide for Pain management and Nursing care for procedures Please pick two topics Thank you 1 Contraindications for vaginal

OB Quiz #2 COPY.docx - Study guide for Pain management and...

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Study guide for Pain management and Nursing care for procedures Please pick two topics. Thank you! 1. Contraindications for vaginal delivery (Tanya) a. Amnionitis i. Inflamed amniotic sac b. Hydramnios i. Excess amniotic fluid c. Known fetal anomaly d. Breech presentation e. Placenta previa, vasa previa or abruption i. Placenta lies low and is covering cervix f. Uterine hypertonus i. Contraction lasting longer than two minutes, effects baby's heartbeat g. Cord prolapse i. Cord drops into cervix before baby h. Brow/face presentation i. Baby’s face is facing up (“down”) i. Non-reassuring fetal heart rate patterns 2. Drugs – duramorph - ( Kathleen ) (morphine) pg 859, Mosby’s. Action - depresses pain impulse transmission at the spinal cord level by interaction with opioid receptors to be used for severe to moderate pain. When used as an epidural 5 mg in the lumbar region; if pain relief does not occur in 1 hr give 1-2 mg epidurally; max 10 mg/24 hr. For a continuous epidural infusion 2-4 mg/24 hr; may give another 1-2 mg. Black Box Warning - may cause respiratory depression, neonatal opioid withdrawal syndrome. Contraindications - hypersensitivity, hemorrhage, bronchial asthma, increased intracranial pressure paralytic ileus, hypovolemia, shock, MAOI therapy. 3. Episiotomy Emily a. Surgical incision of the perineum to enlarge the vaginal opening Indications: -rapid resolution of fetal shoulder dystocia - vacuum extractor-assisted or forceps-assisted births - birth with the fetus in an occiput posterior (face up) position - breech delivery - macrosomic fetus: a big baby, over 8 lbs 13 oz Risks:
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- Infection is the main risk, pain - Studies show that midline episiotomies increase a woman's risk for the more extensive third degree tear Types of episiotomies: - Median(midline) - Advantages: minimal blood loss, little scarring, less postpartum pain - Disadvantages: an added laceration may extend to anal sphincter, limited enlargement of vaginal opening - Mediolateral - Advantages: more enlargement of vaginal opening, little risk of extending to anus - Disadvantages: More blood loss, increased pain, prolonged dyspareunia(painful intercourse) Nursing Considerations: - Upright position while pushing promotes gradual stretching of perineum - Delay pushing until the urge is felt - Perineal massage(can start at 36 weeks) - Observe the perineum for hematoma and edema - Apply cold packs for at least the first 12 hours, then heat applications after 12 hours 4. Forcep delivery -risks to baby and mother- Karina a. Baby: Edema, ecchymosis, caput or cephalohematoma, retinal hemorrhage and ocular trauma Erb’s palsy b. Mother: hematoma, pelvic floor injury, excessive bleeding, and 4th degree lacerations 5. IV access for c/s- Sarah Regional Block anesthesia-Spinal Intradural Associated with hypotension Advantages Immediate onset Smaller drug volume Ease of administration Safe & Fast (used in obstetrical emergencies) Disadvantages High incidence of hypotension Short acting (difficult to maintain coverage for prolonged procedures) Risk of spinal headache
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6. Narcotic analgesia-mom and baby - Val
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