NM704 Final Exam -Learning Guide: Questions With
Correct Solutions
Mode of action of epidurals Right Ans - a. 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.
b. The effect of epidural analgesia depends greatly on the drug, the dose
placed in the
epidural space, and the administration technique (i.e., intermittent versus
continuous
infusion).
Benefits of epidurals Right Ans - a. Women using epidural analgesia have
lower pain scores and are more satisfied with
their analgesia than women using parenteral opioids when the experience of
pain is
evaluated.
Contraindications of epidurals Right Ans - a. Absolute contraindications to
epidural or spinal anesthesia include refusal, inability to
cooperate, skin or soft-tissue infection at the site of needle placement, frank
coagulopathy, untreated sepsis, and maternal hemodynamic instability.
b. Relative contraindications include heparin therapy or thrombocytopenia,
and
neurologic disease of the spinal cord.
Possible complications of epidurals Right Ans - a. Post-dural puncture
headache
b. back pain
c. Side effects of local anesthetic placed in the epidural space include
hypotension,
bladder distention/urinary retention, and leg numbness and weakness.
d. Adverse effects related to performance of the epidural analgesia procedure
are rare,
but include epidural abscess, epidural hematoma serious neurological injury.
e. Inadvertent intrathecal (subarachnoid) or intravascular placement can
result in
toxicity.
,Epidurals effect on the progress of second stage labor, rates of oxytocin
augmentation, operative vaginal births and cesarean births Right Ans - The
largest and most recent of these studies, which was conducted by Zhang et al.
(n =
62,400), found the 95th percentile was approximately 50 minutes longer for
the second stage
in nulliparous women. This extended duration is presumed to occur
secondary to the lack of
sensation for bearing down and perhaps the relaxation of the levator ani
muscles that make
up the pelvic floor. The meta-analyses of RCTs that compared labor outcomes
in women with
and without epidural analgesia have not found epidural analgesia to be
associated with a
prolongation of the second stage of labor in the aggregate.
What the evidence says about epidurals Right Ans - Some women whose
labors are slowed by epidural analgesia and some women whose labors are
faster after epidural analgesia therefore in an aggregate mean duration of the
first stage that is no different than the duration of the first stage in women
who do use epidural analgesia
-epidurals are not associated with increased cesareans but actually increased
operative vaginal birth
-increased incidence of maternal fever
-significant complications are uncommon but blood flow to the uterus
diminishes with hypotension and fetal heart rate decelerations
Maternal, fetal and neonatal side effects of Demerol (Meperidine) Right
Ans - -PROLONGED HALF LIFE
-contains an active metabolite with a 63-hour half-life in the neonate
-fetal exposure is associated with neonatal respiratory depression
-may adversely affect newborn breastfeeding behaviors
know the maternal, fetal and neonatal side effects of Morphine Right Ans -
The largest and most recent of these studies, which was conducted by Zhang
et al. (n =
62,400), found the 95th percentile was approximately 50 minutes longer for
the second stage
, in nulliparous women. This extended duration is presumed to occur
secondary to the lack of
sensation for bearing down and perhaps the relaxation of the levator ani
muscles that make
up the pelvic floor. The meta-analyses of RCTs that compared labor outcomes
in women with
and without epidural analgesia have not found epidural analgesia to be
associated with a
prolongation of the second stage of labor in the aggregate.
know the maternal, fetal and neonatal side effects and appropriate timing of
Nubain (Nalbuphine) Right Ans - Pain relief is reported (anecdotal) to be
superior to that of fentanyl.
May bring about acute withdrawal syndrome in opiate-dependent mother and
baby.
**Contraindicated for use in opiate-dependent woman.
know the maternal, fetal and neonatal side effects of Stadol (Butorphanol)
Right Ans - 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
know the maternal, fetal and neonatal side effects of Sublimaze (fentanyl)
Right Ans - May cause a transient pseudo-sinusoidal FHR pattern.
Not associated with neonatal respiratory depression
Short-acting, less effective than morphine or Demerol, but few side effects
know the maternal, fetal and neonatal side effects of Ultiva (Remifentanil)
Right Ans - May cause significant maternal respiratory depression.
Rapid onset of action and shortest half-life.
Use in clinical practice is controversial.
Frequency of Vital Signs in the second stage of labor Right Ans - BP, HR, RR
every hour
Temp every 2-4 hours when normal and 1-2 hours when abnormal or
membranes have ruptured
Urine output: encourage to empty bladder every 2 hours
Correct Solutions
Mode of action of epidurals Right Ans - a. 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.
b. The effect of epidural analgesia depends greatly on the drug, the dose
placed in the
epidural space, and the administration technique (i.e., intermittent versus
continuous
infusion).
Benefits of epidurals Right Ans - a. Women using epidural analgesia have
lower pain scores and are more satisfied with
their analgesia than women using parenteral opioids when the experience of
pain is
evaluated.
Contraindications of epidurals Right Ans - a. Absolute contraindications to
epidural or spinal anesthesia include refusal, inability to
cooperate, skin or soft-tissue infection at the site of needle placement, frank
coagulopathy, untreated sepsis, and maternal hemodynamic instability.
b. Relative contraindications include heparin therapy or thrombocytopenia,
and
neurologic disease of the spinal cord.
Possible complications of epidurals Right Ans - a. Post-dural puncture
headache
b. back pain
c. Side effects of local anesthetic placed in the epidural space include
hypotension,
bladder distention/urinary retention, and leg numbness and weakness.
d. Adverse effects related to performance of the epidural analgesia procedure
are rare,
but include epidural abscess, epidural hematoma serious neurological injury.
e. Inadvertent intrathecal (subarachnoid) or intravascular placement can
result in
toxicity.
,Epidurals effect on the progress of second stage labor, rates of oxytocin
augmentation, operative vaginal births and cesarean births Right Ans - The
largest and most recent of these studies, which was conducted by Zhang et al.
(n =
62,400), found the 95th percentile was approximately 50 minutes longer for
the second stage
in nulliparous women. This extended duration is presumed to occur
secondary to the lack of
sensation for bearing down and perhaps the relaxation of the levator ani
muscles that make
up the pelvic floor. The meta-analyses of RCTs that compared labor outcomes
in women with
and without epidural analgesia have not found epidural analgesia to be
associated with a
prolongation of the second stage of labor in the aggregate.
What the evidence says about epidurals Right Ans - Some women whose
labors are slowed by epidural analgesia and some women whose labors are
faster after epidural analgesia therefore in an aggregate mean duration of the
first stage that is no different than the duration of the first stage in women
who do use epidural analgesia
-epidurals are not associated with increased cesareans but actually increased
operative vaginal birth
-increased incidence of maternal fever
-significant complications are uncommon but blood flow to the uterus
diminishes with hypotension and fetal heart rate decelerations
Maternal, fetal and neonatal side effects of Demerol (Meperidine) Right
Ans - -PROLONGED HALF LIFE
-contains an active metabolite with a 63-hour half-life in the neonate
-fetal exposure is associated with neonatal respiratory depression
-may adversely affect newborn breastfeeding behaviors
know the maternal, fetal and neonatal side effects of Morphine Right Ans -
The largest and most recent of these studies, which was conducted by Zhang
et al. (n =
62,400), found the 95th percentile was approximately 50 minutes longer for
the second stage
, in nulliparous women. This extended duration is presumed to occur
secondary to the lack of
sensation for bearing down and perhaps the relaxation of the levator ani
muscles that make
up the pelvic floor. The meta-analyses of RCTs that compared labor outcomes
in women with
and without epidural analgesia have not found epidural analgesia to be
associated with a
prolongation of the second stage of labor in the aggregate.
know the maternal, fetal and neonatal side effects and appropriate timing of
Nubain (Nalbuphine) Right Ans - Pain relief is reported (anecdotal) to be
superior to that of fentanyl.
May bring about acute withdrawal syndrome in opiate-dependent mother and
baby.
**Contraindicated for use in opiate-dependent woman.
know the maternal, fetal and neonatal side effects of Stadol (Butorphanol)
Right Ans - 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
know the maternal, fetal and neonatal side effects of Sublimaze (fentanyl)
Right Ans - May cause a transient pseudo-sinusoidal FHR pattern.
Not associated with neonatal respiratory depression
Short-acting, less effective than morphine or Demerol, but few side effects
know the maternal, fetal and neonatal side effects of Ultiva (Remifentanil)
Right Ans - May cause significant maternal respiratory depression.
Rapid onset of action and shortest half-life.
Use in clinical practice is controversial.
Frequency of Vital Signs in the second stage of labor Right Ans - BP, HR, RR
every hour
Temp every 2-4 hours when normal and 1-2 hours when abnormal or
membranes have ruptured
Urine output: encourage to empty bladder every 2 hours
