epidurals flashcards.txt

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meowzart
ID:
42553
Filename:
epidurals flashcards.txt
Updated:
2010-10-16 15:04:03
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epidurals nursing care
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epidural care for nurses
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  1. What is epidural analgesia used for?
    pain management in abdominal and lower extremity surgeries
  2. What are 3 ways epidural analgesia is administered
    • bolus
    • continuous infusion
    • PCA
  3. What lumbar vertebrae are the target sites for epidural analgesia?
    L4-5
  4. Is the needle for epidural injection larger or smaller than a spinal needle?
    larger so a catheter can be threaded through it
  5. What effects will be noted on a test dose if the epidural needle is in the vein?
    immediate increase in heart rate and BP (epinephrine effects)
  6. What are some advantages of epidural analgesia over IV opiods
    • - better pain control
    • - lower stress hormones
    • - better pulmonary function
    • - earlier ambulation
    • - less post op complications
    • - shorter hospital stays
  7. Two most commonly used epidural opioids
    morphine and fentanyl
  8. Is epimorph hydrophilic or lipophilic?
    hydrophilic
  9. Does morphine circulate freely in the CSF in epidural infusions
    yes
  10. Does fentanyl circulate freely in the CSF in epidural infusions?
    no
  11. Is fentanyl lipophilic or hydrophilic?
    lipophilic
  12. Which causes greater resp depression in epidural infusion, morphine or fentanyl and why?
    morphine because it is hydrophilic and circulates freely in the CSF coming in contact with the resp centre
  13. Where does fentanyl tend to accumulate when used in epidural infusion? CSF or fatty tissue?
    fatty tissue
  14. Which causes more sedation in epidural infusion? Morphine or fentanyl
    fentanyl (lipophilic)
  15. List 3 SE of epidural opioids
    • - resp deression
    • - urinary retention
    • - pruritus
    • - N & V
    • - sedation
  16. Duration of morphine in epidurals
    - a) 2-3 hours
    - b) 2-4 hours
    - c) 3-6 hours
    - d) 5-24 hours
    5-24 hours
  17. Duration of fentayl in epidurals
    - a) 2-3 hours
    - b) 2-4 hours
    - c) 3-6 hours
    - d) 5-24 hours
    2-4 hours
  18. What is a commonly used local anesthetic in epidurals
    bupivicaine (marcaine)
  19. what is the onset of action of bupivicaine when used in epidurals
    - a) 2-3 minutes
    - b) 5-10 minutes
    - c) 5-30 minutes
    - d) 10-20 minutes
    5-30 minutes
  20. what is the duration of action of bupivicaine in epidurals
    - a) 1-2 hours
    - b) 2-4 hours
    - c) 3-8 hours
    - d) 10-24 hours
    3-8 hours
  21. List 3 Side effects of bupivicaine in epidurals
    • - hypotention (autonomic blockade)
    • - resp depression
    • - headache
    • - urinary retention
    • - paralysis (migration of catheter to subarachnoid space)
  22. What 2 medications should you have on hand during epidural analgesia
    narcan and ephedrine
  23. List 4 things to assess during epidural analgesia
    • - sedation
    • - pain
    • - sensory/dermatome level
    • - movement - motor function
  24. List 4 complications of epidural analgesia
    • - resp depression
    • - N& V
    • - oversedation
    • - urinary retention
    • - pruritus
    • - motor blocks
    • - extension of numbness level
    • - postural hypotension
    • - catheter migration
    • - disconnected infusion
    • - headache
  25. A motor block is present in epidural infusion if the patient is unable to move which joints?
    toes, feet, ankles, knees, hips
  26. If a motor block is present in epidural analgesia, what action should a nurse take?
    • stop infusion
    • notify anesthetist
  27. Define postural hypotension in terms of epidural analgesia
    20% drop from preop systolic BP
  28. What nursing measures should be employed for postural hypotension in epidural analgesia?
    • lower head of bed flat
    • administer saline bolus
    • notify anesthetist
  29. What are signs that an epidural catheter has migrated in the spinal or vascular space?
    • - hypotension
    • - severe sedation
    • - signs of systemic toxicity (with local anesthetics) eg paralysis, seizures, circumoral numbness

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