Maternal-Newborn Nursing - Exam 1

Terms in this set (65)

local anesthetic + opioid (preservative free fentanyl or morphine) injected into epidural space

pain relief/moderate loss of sedation (cannot ambulate unless only small does of opioid used)

decreased feeling/sensation below level of epidural

contraindications: coagulation defects, uncorrected hypovolemia, allergy

potential adverse effects:
-**maternal hypotension**
-prolonged 2nd stage of labor (decreased urge to push)
-catheter migration/back soreness
-slight fever (unrelated to infection)

DANGER of maternal hypotension & poor placental perfusion
s/s:
maternal hypotension
fetal bradycardia
decreased retail variability (fetus is not being oxygenated well)

interventions:
-turn mom to left lateral position
-increase non-additive IV per protocol (LR, D5 1/2, D5)
-O2 10 L/min
-elevate legs
-notify anesthesiologist
-vasopressor (ephedrine) if needed
-monitor until stable

Epidural - nursing care:
-Bolus patient with 1000 mL fluid prior to procedure (to help prevent hypotension)
-continuous IV fluids
-assist birth attendant during procedure, assist holding pt

-frequent bladder assessment (and catheterize as needed)...they can't feel when they have to pee
-frequent V/S (esp. BP)

-safety precautions r/t decreased sensation
-observe for s/s of adverse reactions/ s/e

potential s/e of opioid analgesics:
-respiratory depression (observe for 24 hr)
-itching (benadryl)
-n/v (phenergan)

Placement:
-Epidural space entered a L3-L4 , and catheter threaded
-Test dose given to check placement , then therapeutic dose
-Infusion can be continuous or intermittent (catheter stays in place)
;