Epidural and DTR

[ibambamama]

Hi there -

New OB nurse here (whoohoo!) I'm about 7 weeks into my orientation and recently have been taking care of a lot of pts. with PIH/PET, almost all of whom end up on Mag Sulfate (blech! - had it myself with my first baby so I know firsthand how crappy it makes you feel!)

So my question is this: I know how important it is to check DTR's when a woman is pre-eclamptic and/or on magnesium, but can anyone tell me how (if at all) epidural anesthesia affects these reflexes? Especially of the lower extremities.

I ask this b.c. I thought I just read in an article yesterday that an epidural would block the reflexes of the lower extremities (and therefore you should use the elbow and bicep reflexes for checking). But then I saw a resident on my floor try to check the achilles reflexes of my pt (who had had an epidural).

Anyone?

[DonnaH123]

You are correct...and I won't elaborate on your comment about the 'resident checking the reflexes'. I'd bet the reflexes were WNL (by the resident's assessment). Stick with your knowledge-you're probably gonna always win! I just had the same issue with a physician and a cervical assessment. The doctor said she was 4cm and when I checked-the patient was about 1cm & stayed there for hours. I questioned the doctor & she said, "You are definitely not correct..." Well, the patient stayed "1cm" for hours and wouldn't you know--she ended up getting sectioned. She was NEVER 4cm. I know and the doctor knows-but I am able to sleep at night!

Maybe you could print off the article you read and bring it to the resident. Ask him/her to explain it to you. Maybe the resident will learn from the experience? They are trained to think like a textbook--the patient is on Mag-therefore, I need to check reflexes. A good resident would have checked the reflexes in both sets of extremities! They don't teach us how to deal with the docs in nursing school & that is one of our hardest challenges!

[FemmeRN]

I check the brachial reflex rather than patellar in women who've had an epidural, for the reason you cited. However, I just realized in reading your post, that I still check for clonus in the ankle by dorsiflexing the foot....did the article you read say anything about that being affected by the epidural? Does anyone know how (or if you can..) check for clonus in the upper extremity? I've only ever heard of it in ankles.

Still learning,

[elanddeenrs]

you can check clonus in the fingers/ hands. have the pt face their hand toward you like they're going to give you a high five, but have them relax their fingers. then, thump the end of the ring finger. if clonus is positive, their fingers will "beat" forward, just like in the foot.