Introduction to Nursing Skills Labs IV Course Outline Lab manual Review Lab Guidelines and Expectations

Epidural Assessment Primarily for acute or chronic pain management, labour, post-surgery, oncology Continuous or Bolus Preservative free meds. Preservatives are neurotoxic to nervous system combined with normal saline (PF) Can be analgesic: ie: epimorphine epifentanyl anaesthetic : ie: Marcaine

Epidural Space

action Introduction of small amounts of narcotics and local anesthetics into the epidural space via a catheter inserted in the lumbar region by an anesthetist Contraindications: CNS infection or trauma on insertion

procedure Anesthesiologist inserts with patient in lumbar puncture position (side lying or sitting)

Sensation A dermatone is an area of skin innervated by the sensory fibers of a single spinal nerve, when local anesthetic agents are used in epidural therapy there exists the possibility of blockade of sensory sensations as well as pain. Dermatone checks assess for sensory changes that would indicate catheter or medication migrations up the epidural space or even into the CSF

Complications of epidurals Not common Infection at the insertion site (fever, headache, discharge at the site) Catheter migration or displacement (headache, loss of motor function, overmedication) Spinal cord damage: very rare caused by hematoma (must ensure all anticoagulants are known by physician)

Side Effects of Opiods Resp. Depression- decrease RR, shallow -decrease LOC Pruitis N & V Urinary Retention- block reflex for sphincter relaxation

Side Effects of Anesthetic Hypotension Nausea Sensory and Motor Loss motor block-excessive blockade of motor nerve roots

Assessments Baseline vital signs Ongoing comparison to baseline Allergies Assess pain Sedation level Sensory Level Volume delivered and attempts made Ability to move, cough handout

Pain and Respiration Analgesia: assess on a scale of 1-10 Breakthrough pain Resp. rate and O2 saturations: if less than 8/min or sats<90% or sedation score of 3 RESP. EMERGENCY Stimulate patient, 02, turn epidural off, notify anesthesiologist, use narcan as per hosp. policy (usually IV runs open with narcan

Sensory Level Common Landmarks T4 nipple line T6 Xiphoid process T12 top of pubis L1 pubis

Technique Using a cold object (ice chips in a glove) test areas to see if there is any change in sensory perception. Patient should look away and describe the sensation. Anesthetic level should be recorded. Significant changes should be reported

Sedation Scale 0= none alert 1= mild easy to rouse 2= moderate increased drowsiness 3= severe difficult to rouse with verbal stimuli s= sleep asleep but easy to rouse

Possible Side Effects at a Glance Nausea and vomiting Pruritis Urinary retention Hypotension Toxicity Headache Epidural site: observe for leakage of blood, drainage or redness

Teaching Usually done pre-op so the patient understands how it works Should provide both written and verbal instructions how to notify staff if inadequate control, change in pain intensity, machine malfunction, alarms

Lab Practice Complete Assessment on your Patient Nursing Care Plan for Epidural Pt.

Sensory Deficits

-Sensory deficit: absent/impaired functioning of one/or more senses Impaired sight Impaired hearing Altered taste Altered tactile perception Impaired kinesthetic sense

Can be Reversible and permanent Gradual or sudden At birth or over time Nurse needs to be aware of all deficits and stage of deficit to assist patient with self-care, safety issues, adaptation abilities, ability to cope with changes

Lab exercises Complete the Following Stations Dyslexia-read/visuals Visually Impaired-handout Kinesthetic/Tactile Hearing Impaired Communication Exercises Adaptations in the Home

Communication Exercise #1 effective communication? barriers? incorporate into nursing practice? #2 what did it feel like for partner 1? partner 2? Correct? Timely? incorporate into Nursing Practice? Adaptation in the Home Environment Handout Questions