Rehabilitation and other non-pharmacologic management options for overactive bladder
Pharmacologic management 7
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Transcript of Pharmacologic management 7
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PHARMACOLOGIC MANAGEMENT
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Learning Outcome
Describe the use of systemic drugs to promote pain relief during labor.
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Goal of Pharmacologic Pain Relief
• Goal is to provide maximum pain relief with minimum risk to mother and fetus
• Goal is impacted by following factors– All systemic drugs used in labor for pain relief
cross placental barrier by simple diffusion– Drug action in body depends on rate at which
substance is metabolized by liver– Fetus has inadequate ability to metabolize
analgesic agent
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What Women Need to Know About Pain-Relief Medications
• Before receiving medications, the woman should understand the following– Type of medication administered– Route of administration– Expected effects of medication– Implications for fetus or newborn– Safety measures needed (e.g., stay in bed
with side rails up)
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Timing of Medication
• After complete assessment, analgesic agent generally administered when cervical change has occurred – pain medication given too early may prolong labor and depress fetus
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Nursing Management
• Drugs may cause fetal respiratory depression at birth if given too late in labor
• Maternal and fetal vital signs must be stable before systemic drugs may be administered
• Assess mother and fetus and evaluate contraction pattern before administering prescribed medications
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Learning Outcome
Compare the major types of regional analgesia and anesthesia, including area
affected, advantages, disadvantages, techniques, and nursing implications.
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Epidural Injection
• Injection of anesthetic agent into epidural space
• Produces little or no feeling to area from uterus downward
• Pushing during second stage of labor may be impaired due to lack of sensation
• Hypotension is most common side effect
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Epidural Injection
• May preload with crystalloid solution bolus
• Woman may need urinary catheterization due to loss of bladder sensation
• Assess sensation motor control and orthostatic blood pressure
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Technique for Lumbar Epidural Block
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Epidural Space
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Continuous Epidural Analgesia
• Provides good analgesia
• Produces less nausea and provides greater ability to cough
• May produce breakthrough pain, sedation, respiratory depression
• Itching and hypotension are side effects
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Spinal Block
• Local anesthetic agent injected directly into spinal canal
• Level of anesthesia dependent upon level of administration
• May be administered higher for cesarean birth or lower for vaginal birth
• Onset of anesthesia is immediate
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Spinal Block
• Side effects include– Maternal hypotension, which can lead to fetal
hypoxia, requiring frequent blood pressure monitoring for health changes
– Indwelling urinary catheter usually needed due to decreased bladder sensation and tone
– Woman’s legs must be protected from injury for 8 to 12 hours after birth of baby due to decreased movements and sensation
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Pudendal Block
• Local anesthesia injected directly into pudendal nerve, which produces anesthesia to lower vagina, vulva, perineum
• Only produces pain relief at end of labor
• Has no effect on fetus or progress of labor
• May cause hematoma, perforation of rectum, trauma to sciatic nerve
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Pudendal Block
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Local Infiltration
• Local anesthesia injected into perineum prior to episiotomy
• Provides pain relief only for episiotomy incision
• There is no effect on maternal or fetal vital signs
• Requires large amounts of local anesthetic agents
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Local Infiltration
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Local Infiltration
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Learning Outcome 20-3
Explain the possible complications of regional anesthesia.
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Complications
• Regional anesthesia administered per spinal or epidural route has similar possible complications– Maternal hypotension from hypovolemia or
effects of anesthesia – treat with bolus of crystalloid IV fluid and notify anesthetist
– Bladder distension– Inability to push during second stage of labor– Severe headache with spinal anesthesia
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Complications
• Regional anesthesia administered per spinal or epidural route has similar possible complications– Elevated temperature with epidural
anesthesia– Possible neurologic damage
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Learning Outcome
Describe the nursing care management for the laboring woman and her fetus related to
general anesthesia.
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Nursing Care Related to General Anesthesia
• Nurse should– Assess when mother ate or drank last– Administer prescribed premedication such as
antacid– Place wedge under mother’s right hip to
displace uterus and prevent vena cava compression
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Nursing Care Related to General Anesthesia
• Nurse should– Provide oxygen prior to start of surgery– Ensure IV access is established– Assist anesthesiologist by applying cricoid
pressure during placement of endotracheal tube
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Proper Position for Cuffed Endotracheal Tube
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Learning Outcome 20-5
Describe the major complications of general anesthesia during labor in nursing care
management of the woman in labor and her fetus.
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Major Complications
• Fetal depression– If mother receives general anesthesia, infant
may have respiratory depression– Method not advocated when infant is
considered high risk
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Major Complications
• Uterine relaxation: Most general anesthetic agents cause some uterine relaxation
• Vomiting
• Aspiration: Agents may also cause vomiting and aspiration