epidural management postpartum

USA987, MSN, RN, NP · Oct 13, 2004

For vag deliveries we do VS q15x5, then q30x2 and then they are usually transported to PP. On PP they are done as part of the admission assessment and then just qshift.

Of course if the pt. is unstable after delivery I will adjust my assessment accordingly. Likewise on PP...if my pt. gets to me with a BP of 150/90 or a temp. of 101...I will adjust my frequency and keep the MD informed.

OBNurseShelley · Oct 13, 2004

I work as a traveler and I have never been anywhere, where assessments change based on an epidural analgesic, typically in recovery they're assessed similar that everyone mentioned, then get routine vitals on PP.

HOWEVER: for spinals using duramorph, they're typically assessed (after recovery) every hour for 8 hours, then every 2 for 12 hours. Then every 4 for the next 24 .

It's my understanding the medication used in epidurals is NOT long acting and there should be no reason to assess these patients for breathing every hour, after an epidural has been turned off.

Maybe, I'm missing something?

labor/rn · Nov 23, 2004

I need some information about the monitoring of patients receiving epidural pain management after delivery. On our postpartum floor we are checking these patients every hour for 24 hours and according to some other hospitals in the area this is overkill. The anesthesia director wants some data. Where do I find that information or do any of you have a policy on epidural monitoring that has references?
Karen

This may have already been stated but whenever we have an epiduralized pt we do dematome and sedation level checks houly. This goes right along with all the other checks that have to be documented (resp, bp, fundal checks). Our documentation is done by a QS system which makes it very simple and easy!

Jemma · Nov 24, 2004

We are getting ready for JCAHO survey and another nearby hospital said the surveyors were requiring documentation specific to recovery after epidural. I don't understand why- if has been discontinued,is it any different from routine recovery after delivery?- did you find anything in your research? Thanks

We also recover women who had an epidural for a vag delivery the same as others- following delivery of the placenta, Q15x4, then Q30x2. If mom is stable at that point we transfer to postpartum standard of care (VS & assessment Q 8hr shift). In unstable, we continue q15 or q30 until stable (if had an epidural, needs to be able to move feet and get OOB with assistance) then transfer to postpartum SOC when she is stable.
We don't really even consider what she had for analgesia in labor after that point, unless she or the baby was negatively affected (such as mom has a spinal headache).
Very few of our pts are medicated with a continuous low dose epidural post-c/section, it's not a popular choice among our providers. Our scheduled sections actually just recieve a spinal, and don't even have an epidural cath placed at all. So they are recovered Q5 until they can move their feet, then (I think) Q15x4, Q30 x 2, Q1hrx2, Q4hr until 48hours out.
Now I'm curious is we're not dropping the ball somewhere with our vag delivered epiduarlized pts. I'll check our references and maybe have the hospital librarian do a literature search.

BETSRN · Nov 24, 2004

I surely think checking O2 sat every hour for all those hours is certainly overkill. Some of our sections get up and out of bed within several hours of delivery. We used to check respirations every hour for several but we rarely do that anymore. We work 1;1 in recovery but after that, we just watch our fresh post-ops as we would any patient. The baby is usually in and out to feed anyway and we see all our patients frequently. Most people have a slew of visitors and they wuld certainly notice if the patient was in distress. Most are opening gifts and visiting with family. Most with duramorph need some anti-itch medicine anyway and we are seeing them pretty frequently as it is. I think much of what is done is overkill. I ahve to say that although we are a low risk unit, I have NEVER seen an adverse reaction post-op.