NM 704 - EXAM 4 QUESTIONS AND ANSWERS WITH
COMPLETE VERIFIED SOLUTIONS
Demerol (meperidine)
Know the significance of the prolonged half-life of this medication
- Has the longest half-life, which is greater risk of respiratory depression in NB for
the longest period of time
- Contains active metabolite w/ 63-hour half-life in neonate
- may temporarily decrease FHR variability
- Fetal exposure is associated with neonatal respiratory depression
- May adversely affect NB BF behaviors
Morphine
- Adjust dose downward for those w/ respiratory issues (asthma, impaired ventilation)
- Itching is a potential side effect
- Most often used for therapeutic rest in early labor
- faster absorption when administered through the deltoid muscle compared to the
gluteal
- Side effects: pruritis, n/v, and urinary retention, can cause respiratory depression as
dose accumulates
Nubain (nalbuphine)
Know the reason to avoid nalbuphine in clients who have received or are receiving
opioid agonist therapy
,- WILL cause acute withdrawal in opiate-dependent patients!
- pain relief is reported (anecdotal) to be superior to fentanyl
- may bring about acute withdrawal syndrome in opiate-dependent mother and baby
- Contraindicated for use in opiate-dependent woman
Stadol (butorphanol)
Know the reason to avoid butorphanol in clients who have received or are receiving
opioid agonist therapy
- WILL cause acute withdrawal in opiate-dependent patients!
- May cause a transient pseudo-sinusoidal FHR pattern
- Pain relief is reported (anecdotal) to be superior to that of fentanyl
- Contraindicated for use in opiate-dependent woman
Sublimaze (fentanyl)
- May cause transient pseudo-sinusoidal FHR pattern
- Not associated with NB respiratory depression
- Short-acting, less effective than morphine or Demerol, but fewer side effects
Ultiva (remifentanil)
- May cause significant maternal respiratory depression
- Rapid onset of action and shortest half-life
- Use in clinical practice is controversial
- dose at the beginning of uterine contraction to maximize peak effect during contraction
Epidurals
Mode of action.
- when an anesthetic drug is placed in the epidural space, impulses traveling in the
,sensory and motor nerves in contact with the drug are blocked
- The effect of epidural analgesia depends greatly on the drug, the dose placed in the
epidural space, and the admission technique (intermittent v continuous infusion)
- most commonly used agent is bupivacaine (Marcaine) and ropivacaine (Naropin);
fentanyl and morphine can be added to potentiate the analgesic effect and allow for
smaller doses of the anesthetic drug
Benefits
- Women using epidurals have lower pain scores and are more satisfied w/ their
analgesia than women using parenteral opioids
- may be beneficial for women with a hx of sexual abuse to reduce anxiety from the
painful stimuli in the vaginal/rectal area or flashbacks of abusive events
Contraindications
- Absolute CI- refuse, inability to cooperate, skin or soft-tissue infection at the site of
needle placement, frank coagulopathy, untreated sepsis, and maternal hemodynamic
instability
- Relative CI- heparin therapy or thrombocytopenia, and neurologic disease of the spinal
cord
- Consultation needed- cardiac disease, hematologic abnormalities or risk factors,
spinal/muscular/neurologic disease, major hepatic or renal disease, hx of or risk factors
for anesthetic complications, obstetric complications that may affect anesthesia
management (placenta accreta, Non obstetric surgery during pregnancy, planned c/s
, with concurrent major abdominal procedure), medical conditions that may influence
anestheia management (BMI, hx solid organ transplant, myasthenia gravis, dwarfism,
sickle cell anemia, neurofibromatosis)
Possible complications
- Postdural puncture headache (resolution is spontaneous within 4-5 days, can be
treated with oral hydration, caffeine, simple analgesics; if severe, blood patch)
- Back pain
- Side effects: local anesthetic placed in epidural space including hypotension, bladder
distention/urinary retention, and leg numbness and weakness
- Adverse effects: rare- epidural abscess, epidural hematoma, serious neurological
injury
- Inadvertent intrathecal (subarachnoid) or intravascular placement can result in toxicity
Effect on the progress of second stage labor, rates
List and describe the components of a continuing evaluation of birthing person
and fetal well-being and labor progress in the second stage of labor including the
recommended frequency for the assessment of birthing person vital signs and
fetal heart rate
Frequency of assessments
- urinary output q2 hours to void
COMPLETE VERIFIED SOLUTIONS
Demerol (meperidine)
Know the significance of the prolonged half-life of this medication
- Has the longest half-life, which is greater risk of respiratory depression in NB for
the longest period of time
- Contains active metabolite w/ 63-hour half-life in neonate
- may temporarily decrease FHR variability
- Fetal exposure is associated with neonatal respiratory depression
- May adversely affect NB BF behaviors
Morphine
- Adjust dose downward for those w/ respiratory issues (asthma, impaired ventilation)
- Itching is a potential side effect
- Most often used for therapeutic rest in early labor
- faster absorption when administered through the deltoid muscle compared to the
gluteal
- Side effects: pruritis, n/v, and urinary retention, can cause respiratory depression as
dose accumulates
Nubain (nalbuphine)
Know the reason to avoid nalbuphine in clients who have received or are receiving
opioid agonist therapy
,- WILL cause acute withdrawal in opiate-dependent patients!
- pain relief is reported (anecdotal) to be superior to fentanyl
- may bring about acute withdrawal syndrome in opiate-dependent mother and baby
- Contraindicated for use in opiate-dependent woman
Stadol (butorphanol)
Know the reason to avoid butorphanol in clients who have received or are receiving
opioid agonist therapy
- WILL cause acute withdrawal in opiate-dependent patients!
- May cause a transient pseudo-sinusoidal FHR pattern
- Pain relief is reported (anecdotal) to be superior to that of fentanyl
- Contraindicated for use in opiate-dependent woman
Sublimaze (fentanyl)
- May cause transient pseudo-sinusoidal FHR pattern
- Not associated with NB respiratory depression
- Short-acting, less effective than morphine or Demerol, but fewer side effects
Ultiva (remifentanil)
- May cause significant maternal respiratory depression
- Rapid onset of action and shortest half-life
- Use in clinical practice is controversial
- dose at the beginning of uterine contraction to maximize peak effect during contraction
Epidurals
Mode of action.
- when an anesthetic drug is placed in the epidural space, impulses traveling in the
,sensory and motor nerves in contact with the drug are blocked
- The effect of epidural analgesia depends greatly on the drug, the dose placed in the
epidural space, and the admission technique (intermittent v continuous infusion)
- most commonly used agent is bupivacaine (Marcaine) and ropivacaine (Naropin);
fentanyl and morphine can be added to potentiate the analgesic effect and allow for
smaller doses of the anesthetic drug
Benefits
- Women using epidurals have lower pain scores and are more satisfied w/ their
analgesia than women using parenteral opioids
- may be beneficial for women with a hx of sexual abuse to reduce anxiety from the
painful stimuli in the vaginal/rectal area or flashbacks of abusive events
Contraindications
- Absolute CI- refuse, inability to cooperate, skin or soft-tissue infection at the site of
needle placement, frank coagulopathy, untreated sepsis, and maternal hemodynamic
instability
- Relative CI- heparin therapy or thrombocytopenia, and neurologic disease of the spinal
cord
- Consultation needed- cardiac disease, hematologic abnormalities or risk factors,
spinal/muscular/neurologic disease, major hepatic or renal disease, hx of or risk factors
for anesthetic complications, obstetric complications that may affect anesthesia
management (placenta accreta, Non obstetric surgery during pregnancy, planned c/s
, with concurrent major abdominal procedure), medical conditions that may influence
anestheia management (BMI, hx solid organ transplant, myasthenia gravis, dwarfism,
sickle cell anemia, neurofibromatosis)
Possible complications
- Postdural puncture headache (resolution is spontaneous within 4-5 days, can be
treated with oral hydration, caffeine, simple analgesics; if severe, blood patch)
- Back pain
- Side effects: local anesthetic placed in epidural space including hypotension, bladder
distention/urinary retention, and leg numbness and weakness
- Adverse effects: rare- epidural abscess, epidural hematoma, serious neurological
injury
- Inadvertent intrathecal (subarachnoid) or intravascular placement can result in toxicity
Effect on the progress of second stage labor, rates
List and describe the components of a continuing evaluation of birthing person
and fetal well-being and labor progress in the second stage of labor including the
recommended frequency for the assessment of birthing person vital signs and
fetal heart rate
Frequency of assessments
- urinary output q2 hours to void
