Continuous Epidural Analgesia

cdunbar4's version from 2016-09-10 17:32

Nurse's role

Question Answer
Continuous epidural analgesia is used to manage pain after _______, _________, & ________ surgery.thoracic, abdominal and orthopedic
How does it work?by blocking transmission of pain at the spinal cord & can blunt the surgical stress response, ↑ postop pulmonary function, ↓ post op thrombosis.
Why is it so helpful to give a client continuous pain relief of an epidural as opposed to other pain control methods?less pain = more adherence with post op plans
Example of a surgery in which epidurals can't control pain of.craniotomies, d/t location of stimulus & RF epidural hematoma among pt's on antigcoagulants
Who is allowed to insert & manage epidural catheters? (at most hospitals)anesthesiologists & CRNAs
Nurse's role obtaining informed consent.provide forms, witness pt. signature, ease communication b/t pt & anesthesia provider
Positions to place patient in:lateral decubitus (fetal) or seated on edge of bed, slightly bent forward w feet dangling
Nurse's role during catheter insertion: pt. safety during positioning, monitor VS (plus SaO2), provide reassurance/comfort
A test dose is given to ensure proper placement, what are some of the expected effects of test dose?change in HR/BP, change in sensation below insertion site, also: palpitations, H/A, resp. depression & dizziness
Epidural tubing must have no injection ports to prevent administration of meds into epidural space. What else can be done to ensure this doesn't happen?Can use different colored tubing with a big tab labeled "EPIDURAL CATHETER"
Can a nurse inject solutions into the epidural catheter?No, only anesthesa providers are allowed.
Nurse's responsible for what r/t administration of epidural meds?Infusion pump system. Monitor & maintain per provider order.
Two categories of meds for epiduralsOpioids & local anesthetics (usually are used together)
How do these meds work?diffuse into CSF in subarachnoid space. Act on spinal cord & nerve roots to block conduction of pain stimuli to brain
What are the 2 other names for epidural analgesia?"painting the fence" & segmental blockade
segmental blockadeachieve blockade for specific dermatone range while sparing dermatone levels below range.

Effects of Opioids

Question Answer
Common opioids usedmorphine sulfate (Duramorph), fentanyl citrate (Sublimaze) & sufentanil citrate (Sufenta)
Respiratory depression is a RR of ______ & O2 sat of?<8/min & O2 < 90% and a ↓ LOC
If respiratory depression occurs....stop infusion, administer 0.4mg naloxone HCl (Narcan) as long as you have a standing order. Ventilate with ambu bag if patient stops breathing, call ER
How long after morphine is stopped can respiratory depression occur?20 hours
Urinary retention patient may feel like they need to urinate but can't, check bladder distention if no voiding in 6-8hrs, may need catheterization
Itching is most often treated: 25mg Benedryl Q4 IV
Sympathetic blockade of local anesthetics effects:vasodilation, hypotension, & motor blockade which hampers ability to move
Common local anesthetic meds:lidocaine HCl (Xylocaine), bupivacaine HCl (Marcaine, Sensorcaine) & ropivacaine HCl (Naropin)

Complications to watch for

Question Answer
Nurses roles include pt teaching, assessing levels of pain relief & sensory motor blockade, but most important to watch for?complications
abscess symptoms begin in _________-___ days post-op1-3
Symptoms of abscess include: back pain, fever, flaccid paralysis followed by spastic paralysis, ↑WBC count, sensory & motor changes & a positive Brudinski's sign (involuntary flexion of hips when pts neck is flexed)
Treatment of abscessesantibiotics & surgery
Epidural hematoma manifests with:severe back pain, lower extremity paresthesia & a change in sensory or motor function w/o definable cause
If you suspect epidural hematoma what should you do?call anesthesiologist ASAP
What class of medication ↑s chance of patient getting an epidural hematoma?anticoagulants
Cauda equina syndrome symptoms; what do you do if you see these?back pain, motor weakness in LE, sensory deficits, urinary retention, "saddle" anesthesia: Report immediately, can cause paralysis!
catheter migrationcauses nausea, ↓BP & loss of motor function w/o definable cause; call anesthesia ASAP
sympathetic blockade is characterized by: Nursing intervention?↓BP & sometimes ↓HR. Have pt lie flat w legs elevated, notify anesthesia (most likely will administer IV bolus of ephedrine sulfate)
Toxicity will manifest differently according to drug, but generally:lightheaded, numbness of lips & tongue, visual & auditory disturbances, muscle twitches, unconsciousness, seizures, coma, resp. arrest, prolonged PR & QRS intervals, bradycardia & sinus arrest
Allergic Rxn is serious characterized by: Nursing intervention?hives, resp. distress, & anaphylaxis. STOP infusion, notify anesthesia & begin supportive measures
What happens if there is a dural puncture?CSF fluid is aspirated, client has 80% chance of developing H/A that starts in occipital area
Nausea is common, how is it usually treated?10mg IV metoclopramide (Reglan) Q6
Breakthrough pain can occur, what should you NOT do if this happens?Do NOT give additional oral or parenteral narcotics w/o express order of anestehsia provider. They may order 15-30mg of IV ketorolac tromethamine (Toradol) or an manual bolus of epidural med
Limited mobility is common, what are some precautions to keep in mind?Don't let patient get out of bed w/o assistance & only if approved. elevate HOB 30-40degrees.
Aside from VS, what other things is the nurse responsible for monitoring?sedation levels, dressing, system checks

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