Question

1. Your patient is in active labor. An epidural anesthetic is ordered. Describe the care for the patient before, during and after administration of an epidural and the complications associated with them. Are there any contraindications that the nurse should be aware of?

Answer 1

ANSWER :

CARE BEFORE EPIDURAL ADMINISTRATION

1)Explain the procedure to the gravida

2)Check level of mobility, level of consciousness and vital signs.

3)Fetal heart rate should be checked prior to the procedure

4)Since most sensation in the pelvic area is lost, it is very important to encourage the woman to empty the bladder before the procedure.

5)The patient's back should be prepared with an antiseptic solution such as providon iodine

6)Intravenous solution should be started in order to prevent hypotension.

7)Help the woman to maintain the position if either the sitting or lateral position is used.

CARE DURING EPIDURAL ADMINISTRATION

1)Closely monitor vital signs, pain, intensity rating, sedation score and degree of motor and sensory block

2)Blood pressure should be checked every 5 minutes for the first 15 minutes and every 15 minutes thereafter.

3)Assess for signs and symptoms of complications associated with the use of epidural analgesia including hypotension, nausea, vomiting, urinary retention and motor block

4)A significant drop in blood pressure should be immediately treated by position change, a bolus of IV fluids or vasopressor if necessary.

5)Frequent observation of bladder status is essential during epidural administration.

CARE AFTER EPIDURAL ADMINISTRATION

1)The catheter has to be removed and small dressing will be applied to the site

2)The uncontrollable shaking of the legs or chilling that may experience may be exaggerated due to the epidural induced increased vasodilation and subsequent loss of body heat. The patient should be assured that this is normal physiological response.

3)Care should be taken when the mother stands for the first time, since there may be residual muscle weakness.

COMPLICATIONS OF EPIDURAL ANAESTHESIA

There are some complications with epidural anaesthesia

1)Delayed onset of breast feeding and shorter duration of breast feeding :In a study looking at breastfeeding 2 days after epidural anaesthesia, epidural analgesia caused women to have significant lower oxytocin and prolactin levels in response to the baby breastfeeding on day 2 postpartum which means less milk is produced.

2)Epidural tap:Epidural veins can be inadvertently puncturised with the needle during the procedure. This is common occurance and is not usually considered a complication. However, people who have coagulopathy may be at risk of epidural haematoma.

CONTRAINDICATIONS

1)Low platelet without abnormal bleeding

2)Severe haematologic coagulopathy

3)Infection near the site of injection

4)Progressive neurological disease

5)Decreased but stable cardiac output

6)Hypovolemia

7)Systemic infection

8)Increased intra cranial pressure

9)Allergy to local anaesthetics or opioids

10)Safety concerns including inadequate equipment, experience or appropriate supervision.