I've stumped myself with a question I made on my own! It's so NCLEXy though, I apologize.
Say you have a patient who is six hours postpartum, and she is complaining of a headache. She's had an epidural and has a history of gestational HTN. What would your first nursing action be?
a. administer Tylenol
b. check BP
c. check epidural site
I know it isn't A. I would guess that it would be B though, since blood pressure high enough to give you a headache is a major problem, and eclampsia is still a risk in the postpartum period... right? I just want feedback to reassure myself that a CSF leak from the epidural site wouldn't be the most critical thing.
So, have your patient lie flat while you take her BP.
Seriously, headaches serious enough to warrant a patch are comparatively rare where I work. Elevated blood pressures are more common.
An epidural headache will eventually resolve on its own even if no intervention is done. I'm not minimizing the importance of pain relief in the meantime, but the patient is not usually in a risky situation.
An elevated BP, however, is a different matter. You can have a mom who spikes after delivery. She may have been in the early stages of PIH an not have been diagnosed prior to delivery. Yes, the delivery will head off the worst problems, but PIH can take 1-2 days to resolve. This is also true for diagnosed PIH. Sometimes the need to start or continue mag is evident right away. But in other cases it isn't. At any rate, an epidural leak isn't life-threatening, but a drastically elevated or climbing BP certainly can be.
Vital signs are the way to go in this situation.
I didn't think patches were so uncommon :/
My only advice is don't offer a caffeine drip when it's really bad, doesn't help
lrobinson5
691 Posts
I didn't think patches were so uncommon :/
My only advice is don't offer a caffeine drip when it's really bad, doesn't help