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Pain Management & FHR Monitoring Non- pharmacological methods ➢ Aromatherapy ➢ Imagery ➢ Music ➢ Effleurage: light, gentle circular stroking of the client’s abdomen with the fingertips in rhythm with breathing during contractions ➢ Sacral Counter-pressure: Consistent pressure is applied by the support person using the heel of the hand or fist against the client’s sacral area to counteract pain in the lower back Pharmacological Methods (Sedative & Opioid analgesics) Sedative puts baby at risk for respiratory depression Opioid Analgesic puts mom at risk for sedation, hypotension, and increased variability in FHR Epidural Analgesia Provides lack of sensation at level of the umbilicus to the thighs.➢ Needs to be dilated at least 4cm or above
➢ Side effects include: maternal hypotension and fetal bradycardia.
➢ Nursing Interventions Give IV Bolus to counteract hypotension; want to avoid supine hypotension syndrome (avoid this by placing patient on her side and not on her back).Spinal Block: provides lack of sensation from the nipples to the feet. Given for C-Sections.➢ Side effects include: maternal hypotension and fetal bradycardia, potential headache from leakage of CSF, and increase incidence of bladder and uterine atony.➢ Nursing Interventions Give IV Bolus to counteract hypotension; want to avoid supine hypotension syndrome (avoid this by placing patient on her side and not on her back).
FHR Monitoring (VEAL CHOP) ➢ 110-160 FHR BPM is normal ➢ Want variability (moderate), accelerations are okay ➢ Variable Deceleration Cord Compression ✓ Interventions ▪ Reposition client to side or knee chest position ▪ Discontinue Pitocin ▪ Administer O2 ➢ Early decelerations are okay (Compression of fetal head during contraction) ➢ Late Decelerations uteroplacental insufficiency (lack of fetal O2) ✓ Interventions ▪ Assist mom to side laying position.▪ Increase IV Fluids ▪ Stop Pitocin.▪ Administer O2 ▪ Notify PCP ➢ DO NOT want late and variable decelerations.
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