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The nurse is also caring for the mother and baby during this stage. Types of pharmacological management of Labor DiscomfortoMorphine- oButorphanol (Stadol)- oNalbuphine (Nubain)- oSublimaze (Fentanyl)- oMeperidine (Demerol)- Gate Control theory of pain:onon-painfulinput closes the "gates" topainfulinput, which preventspainsensation from traveling to the central nervous system.Nursing actions before, during and after epidural administrationoBEFORE and DURING:Local- anesthetic injected into perineum at episiotomy site
West Coast UniversityPage 12RF: 01/14/18Regional (Pudendal Block)- Anesthetic injected in pudendal nerve (close to ischial spines) via needle known as the “trumpet”.Epidural Block- Anesthetic injected into the epidural space, located outside the dura mater between the dura and spinal canal via an epidural catheter. Spinal Block: Anesthetic injected in the subarachnoid space General Anesthesia: use of IV injection or inhalation of anesthetic agents that render the woman unconscious.oAFTER:Monitor for pruritus (very common), nausea, vomiting and post-procedural headacheMeasure vital signs every 15 minutes, observing for elevated blood pressure and any respiratory depression.Assess fetal heart rate every 5-15 minutesFacilitate upright or lateral positioning with uterine displacement. Assess for effectiveness of epidural and the woman’s pain level and description of the painAssess for sedation if opioid medication is administered with local anesthesia. Assess level of motor blockadeChapter 9: Durham Define:Baseline FHRoMean fetal heart rate (FHR) rounded to increments of 5 beats per minute during a 10- min window, excluding accelerations and decelerations.Baseline variabilityoFluctuations in the baseline FHR that are abnormal in amplitude and frequency.Characteristics:Absent: Amplitude range is undetectableMinimal: Amplitude range is undetectable <5 bpm rangeModerate: Amplitude from peak to trough 6 bmp to 25 bpm. Moderate variability predicts a well-oxygenated fetus with normal acid-base balance at the time.
West Coast UniversityPage 12RF: 01/14/18Marked: Amplitude range greater than 25 bmpAccelerationsoFHR accelerations’ caused by adequate central fetal oxygenation and reflects the absence of fetal academia. oThe absence of FHR accelerations, especially in the intrapartum period, does not necessarily predict fetal academia oFHR accelerations are the visually abrupt, transient increases (onset to peak <30 seconds) in the FHR above the baselineIntrauterine Resuscitation Interventions(p. 249)oMaternal positioning to minimize or correct cord compression and decrease frequency of UCs and improve uterine blood flow.oAdminister IV bolus of fluid of at least 500 mL of lactated ringers to maximize maternal intravascular volume and improve uteroplacental perfusion.