to epidural or not…that is the question?? ashley rigby brittney bunnell heather lee erika...
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To Epidural or not…That is the question??
Ashley Rigby
Brittney Bunnell
Heather Lee
Erika Highstead
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Lumbar Block Overview
Involves injection of a local anesthetic agent into the epidural space
Space between the dura mater and ligamentum flavum
Assessed through lumbar area
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Block the Pain
Technique most often is a continuous block
Start of Active Labor through the episiotomy repair
Pain Relief is achieved in 85% of women12% experience partial relief3% no pain relief
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Cultural Factors- France
Epidural during labor is suppose to be available to all women
8,233 low risk women were selected2,720
37% decided not to have one43.9% labor occured to quickly3.3% medical contraindications2.8% anesthesiologist not available
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Cultural Factors- U.S.
Medicaid Woman of Georgia29,833 Met Criteria15,936 (53.4%) Chose to have
epidural
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Cultural Factors- U.S.
Racial and Ethnic ComparisonsAfrican Americans 49.5%Hispanic: 35.5%Asian: 48.1%White (non-hispanic) 59.6%Race/ethnicity a significant predictor of
epidural analgesia
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Signs and Symptoms
Some women come into labor with the intention of having a natural labor but the pain can be too much and they can change their mind
The main sign or symptom to give an epidural is pain
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Effects of epidural on Laboring mother:
Hypotension: this can cause decreased blood flow to the fetus
Fever over 100.4Decreased mobility, inability to urinateNausea/ vomitingPruritusSedation and Drowsiness3rd and 4th Degree lacerations
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Effects of Epidural on Fetus during labor
Fetal MalpositionFetal Heart rate abnormalities
Tachycardia or bradycardia
Late or variable decelerationsMeconium stained fluid
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Effects of progress of labor/effects on mode of delivery
Increased use of ptocin
Decreased rate of dilation
Diminished ability to push
Longer labor over all
Reduced chance of spontaneous vaginal delivery
Instrumental vaginal delivery
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Effects on maternal postpartum
Urinary retention/incontinenceThe following are rare but serious:
MeningitisPostdural puncture seizuresCardiorespiratory arrestVertigo
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Effects on newborn
Increase in hyperbilirubinemiaThere are studies that show there is
a relationship between the success of breastfeeding right after delivery and whether the mother was given an epidural or not.
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Toxic affect of Epidural
Toxic effects due to anesthetic overdose primarily effect the Central Nervous System and Cardiovascular System. The nervous system is more susceptible to toxicity; therefore, will be the first to show signs followed by the cardiovascular.
CNS: Tinnitus, Dizziness, Seizures, Abnormal Taste CVS: Bradycardia (no adrenaline in drug), tachycardia
(if there is adrenaline), arrythmias, Bupivacaine is considered to be the most cardiotoxic
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Impact on Nursing Care:
Rise in elective C-sections because of "pain free delivery"
Higher risk patient? potential complicationslonger laborFHR
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Impact on Nursing Care:
Nurses work load increases slightly: acts as advocate to correct informationmonitoring of V/S and FHR risk for Hypotension----preloadingTemporary changes in bowel elimination and
placement of catheterAdministering single doses, or "topping it off”another site for possible infectionmonitoring for side effects
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Impact on nursing care:
Nursing care benefitsMom's in less, or no pain = less call light use
and uncomfortableness makes transitioning through labor and being
able to save energy for the delivery and recovery
Easier to make a connection and help the mom get through labor
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Interventions/ Treatment
Pre-Epidural IV FluidsEducationAdvocateVitalsAssess Labor ProgressCheck Lab ValuesAnswer any questions
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Interventions/ Treatment
During Epidural insertion:PositioningSupportHelp woman with breathing techniqueAlert anesthesiologist when
contractions occurMonitor maternal and fetal vital signs
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Interventions/ Treatment
Post-epiduralAssist patient into positionMonitor maternal blood pressure1:1 nurse- patient careIndwelling catheterMonitor temperatureConstantly communicate
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Implications on Nursing Practice
Effects on Breastfeeding?Are the side affects worth it? Pain being “unatural”Effects during labor- injuries?
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References
• Durham, J. (2003). Side effect of epidurals: a summary of recent research data.
International Journal of Childbirth Education, 18(3), 11-17.
• Davidson, M.R., London, M.L., Ladewig, P.A. (2008). Maternal-Newborn Nursing and
Women’s Health Across the Lifespan. Pearson Education, Inc. Upper Saddle River, New Jersey.
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• Goodfellow, C.F. (1983). Oxytocin in Epidural Analgesia. British Journal of Obstetrics and Gynecology, 90, 214-219.
• Rust G, Nembhard W, Nichols M, et al (2004). Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery.
American Journal of Obstetrics and Gynecology, 191 (2), 456-462.
• Le Ray C, Goffinet F, Palot M, et al (2008). Factors Associated with the choice of Delivery without Epidural Analgesia in Women at Low Risk in France. Birth, 35(3), 171-178.