NURSE-UN 1242 Lecture Notes - Lecture 5: Hydroxyzine, General Anaesthesia, Pain Management
5 Jan 2019
School
Department
Course
Professor
Week 5 III: Pharmacologic and Non-pharmacologic Pain Management →8 questions
1
1) Cause of pain on labor and birth
a) First stage of labor
i) Progressive cervical dilation
ii) Intensity and duration of contractions
iii) Pressure from fetal position
b) Second stage of labor
i) Perineal distention
c) Third & fourth stages of labor
i) Contraction of the uterus
2) Pain management
a) Nursing roles
i) Offer alternative therapies if pharmaceuticals not desired
ii) Support decision for pharmaceutical pain relief
iii) Support changes in decision
iv) Educate about options
v) It’s important to ask for the patient’s preference
b) Options
i) Non-pharmacologic methods
(1) Relaxation breathing
(2) Touch, Massage and Counter Pressure
(3) Positioning
(4) Hydrotherapy
(5) Acupressure / acupuncture
(6) Music
(7) Aromatherapy
ii) Analgesia vs anesthesia
(1) Analgesia: pain relief, changes the way you perceive pain (Tylenol, Morphine)
(2) Anesthesia: blocks the conductive pathway- nerve block
(a) General anesthesia puts you to sleep
iii) Analgesia
(1) Systemic Analgesia
(a) Important factors
(i) Patient’s medical status
(ii) Labor progress/labor status
(iii) Potential effects on fetus **systemic WILL cross placenta**
(b) Sedatives
(i) Not common
(ii) Early latent phase use, for relaxation & sleep
(iii) Common medications
1. Barbiturates: Seconal and Ambien
2. Benzodiazepines: Valium
3. H1-receptor antagonists: Phenergan, Vistaril, Benadryl (also antiemetic)
(c) Narcotics
(i) Active phase use
1. IV push, systemic, will cross the placenta!!!
(ii) Common medications
1. Stadol (Butorphanol tartrate)
2. Nubain (Nalbuphine hydrochloride)
3. Sublimaze (Fentanyl)
(iii) Risks
1. Respiratory depression→have Naloxone in hand for baby and mother
a. For ALL systemic analgesics and anesthesia
b. Just because you don’t see it from the mother doesn’t mean you won’t see it in the baby
2. Patient gets sleep: safety, somnolence
a. What do to: dangle their feet, assist them until they are stable
b. Supervision ambulation
3. Might cause nausea and vomiting
(d) Nursing considerations
(i) Patient assessment pre and post administration
1. Response to medication
