CASE Assignment :

Giselle is a 30-year-old gravida 1, para 0 admitted at 39 weeks gestation in early active

labor. Her cervical examination is 3 cm/100%/1 vertex. Her membranes are intact. Her
contractions are every 4 minutes and last approximately 60 seconds. Fetal heart rate is 140
beats per minute with moderate variability, accelerations present, and no decelerations.
Giselle declines medication for pain at this time, but she states she might want something
later. Her partner is at the bedside and appears anxious.
1. How can the nurse help Giselle cope with the pain of contractions at this time in
labor?

_The Standard of care for labor nurses are to first provide or encourage a variety of non-
pharmacologic measures are usually simple, safe, and inexpensive to use before to
pharmacologic interventions.
Nonpharmacological measures may include: continuous labor support, hydrotherapy,
ambulation and position changes, acupuncture and acupressure, attention focusing and imagery,
therapeutic touch and massage, and breathing techniques and effleurage.
_ Methods are based on the gate control theory of pain, which proposes that local physical
stimulation can interfere with stimuli by closing a hypothetical gate in the spinal cord, thus
blocking pain signals from reaching the brain.

2. Four hours later, Giselles contractions are every 3 minutes and significantly
stronger. Her cervix is now 6 cm/100%/0 station. She is requesting medication for
pain but is not sure whether she wants an epidural analgesic or an intravenous (IV)
pain medication. How can the nurse counsel her regarding her choices?
3.
Epidural analgesia benefits:
Used during last part birth and for episiotomies; epidural - intrathecal routes are used for pain
relief during active labor and birth.
_ The major advantage of regional pain-management. Technique in which the woman can
participate in the birthing process because is local infiltration (analgesia & anesthesia) and
pudendal route used.

Epidural analgesia drawbacks:

An epidural is contraindicated for women with a previous history of spinal surgery or spinal
abnormalities, coagulation defects, infections, hypovolemia and woman who is receiving
anticoagulation therapy.
_ Complications in the labored woman include nausea and vomiting, hypotension, fever,
pruritus, intravascular injection, and respiratory depression.
_ Effects on the fetus during labor include fetal distress secondary to maternal hypotension

4. Giselle decides to use IV pain medication, and the nurse-midwife orders 2 g of

Butorphanol IV. What should the nurse do to manage the administration of the
medication safely and the subsequent care of the patient?
Patient & Family Nursing Implications Do not breast feed without consulting physician.
Precautions while taking this drug CNS DEPRESSANTS augment CNS and respiratory depression.
Monitor vital signs, oximetry, fetal heart rate, educate the patient and family for adverse effects
and fall precautions.

Note: If used during labor or delivery, observe neonate and mother for signs of
respiratory depression.
Note: Drug can induce acute withdrawal symptoms in opiate-dependent patients.
Lie down to control bradycardia, hypotension, drug-induced nausea.
Do not take alcohol or other CNS depressants with this drug without consulting physician
because of possible additive effects. IM. Do not give more 4 mg/single dose.
Do not drive or engage in other potentially hazardous activities until response to drug is
known.

5. Giselle suddenly feels an urge to push and experiences spontaneous rupture of

membranes 1 hour after the administration of the butorphanol. The nurse midwife
examines Giselle and finds her to be completely dilated with the vertex at +2
station. What should the nurse anticipate? What preparations and plans should be
made?

Butorphanol Tartrate, (Stadol)_Opiod analgesic. Injectable, nasal spray.

The FDA. U.S. has pregnancy warnings, category C.
Reported a higher frequency of stillbirths and a higher incidence of post
implantation loss than controls in human pregnancy before 37 weeks gestation.
High risk for addiction and dependence.
Can cause respiratory distress and death when given high doses or when combined
with other substances, especially alcohol.
Butorphanol should be used during pregnancy only if the potential benefit justifies the
potential risk to the infant.