The nurse is also caring for the mother and baby during this stage Types of

The nurse is also caring for the mother and baby

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The nurse is also caring for the mother and baby during this stage. Types of pharmacological management of Labor Discomfort o Morphine- o Butorphanol (Stadol)- o Nalbuphine (Nubain)- o Sublimaze (Fentanyl)- o Meperidine (Demerol)- Gate Control theory of pain: o non- painful input closes the " gates " to painful input, which prevents pain sensation from traveling to the central nervous system. Nursing actions before, during and after epidural administration o BEFORE and DURING: Local- anesthetic injected into perineum at episiotomy site
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West Coast University Page 12 RF: 01/14/18 Regional (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. o AFTER: Monitor for pruritus (very common), nausea, vomiting and post- procedural headache Measure vital signs every 15 minutes, observing for elevated blood pressure and any respiratory depression. Assess fetal heart rate every 5-15 minutes Facilitate upright or lateral positioning with uterine displacement. Assess for effectiveness of epidural and the woman’s pain level and description of the pain Assess for sedation if opioid medication is administered with local anesthesia. Assess level of motor blockade Chapter 9: Durham Define: Baseline FHR o Mean fetal heart rate (FHR) rounded to increments of 5 beats per minute during a 10- min window, excluding accelerations and decelerations. Baseline variability o Fluctuations in the baseline FHR that are abnormal in amplitude and frequency. Characteristics: Absent: Amplitude range is undetectable Minimal: Amplitude range is undetectable <5 bpm range Moderate: 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.
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West Coast University Page 12 RF: 01/14/18 Marked: Amplitude range greater than 25 bmp Accelerations o FHR accelerations’ caused by adequate central fetal oxygenation and reflects the absence of fetal academia. o The absence of FHR accelerations, especially in the intrapartum period, does not necessarily predict fetal academia o FHR accelerations are the visually abrupt, transient increases (onset to peak <30 seconds) in the FHR above the baseline Intrauterine Resuscitation Interventions (p. 249) o Maternal positioning to minimize or correct cord compression and decrease frequency of UCs and improve uterine blood flow. o Administer IV bolus of fluid of at least 500 mL of lactated ringers to maximize maternal intravascular volume and improve uteroplacental perfusion.
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