322-0521 LABOR EPIDURAL INTRATHECAL ORDERS rev 11-09

LABOR EPIDURAL /
INTRATHECAL ORDERS
DX:
DRUG
ALLERGIES:
HT:
WT:
DATE & TIME
ANOTHER BRAND OF DRUG IDENTICAL IN FORM AND CONTENT MAY BE DISPENSED UNLESS CHECKED
LABOR EPIDURAL / INTRATHECAL ORDERS
1. Pre-hydrate patient with 500-1000 ml LR over 15-30 minutes.
2. This patient has received the following: (drug) (dosage)
(drug)
(dosage)
route of administration: epidural intrathecal at : AM / PM
3. Epidural infusion of: at ml / hour
4. Epidural bolus set at ml every minutes prn pain, to be pushed by patient / RN
5. Adjunctive medications:
A. naloxone (Narcan) 0.1 mg IV push q 3 hours prn itching
B. ondansetron (Zofran) 4 mg IV q 4 hours prn nausea; if no relief in 15 minutes, may give:
C. metoclopramide (Reglan) 10 mg IV q 6 hours prn nausea
D. Other:
6. No additional po, transdermal, sc, IM, or IV narcotics / sedatives to be given, except on order of anesthesiologist,
until epidural is discontinued.
7. Maintain intravenous infusion.
8. Monitoring: (unless otherwise ordered)
A. BP-P-RR q 5 minutes x 3, q 15 minutes x 3, q 30 minutes thereafter until epidural is discontinued
B. Respiratory depression or obtundation:
1) Notify anesthesiologist STAT if RR less than 10, or for any evidence of respiratory difficulty.
2) If severe respiratory depression (RR less than 8), apneic episodes, or cyanosis occur:
a. Administer naloxone (Narcan) 0.2 mg IV push and repeat every 60 seconds until RR is greater
than 10.
b. Administer oxygen by face mask or ambu bag as necessary.
C. Mental Status - If patient develops deterioration in mental status, call anesthesiologist STAT.
D. Call anesthesiologist if pain control is inadequate, patient has weakness or numbness greater than T6 (i.e.
breasts are numb), or for pump malfunction.
E. Monitor oxygen saturation prn.
F. Do NOT "flush" epidural catheters.
9. Keep oxygen flow meter, resuscitation bag with face mask & connecting tubing, and wall suction set up with
Yankauer suction, at bedside.
10. Discontinue infusion at delivery or by request of obstetrician.
NURSE’S
INITIALS
FORM 322-0521 Rev. 11/09
LABOR EPIDURAL / INTRATHECAL ORDERS

LABOR EPIDURAL /
INTRATHECAL ORDERS
DX:
DRUG
ALLERGIES:
HT:
WT:
DATE & TIME
ANOTHER BRAND OF DRUG IDENTICAL IN FORM AND CONTENT MAY BE DISPENSED UNLESS CHECKED
LABOR EPIDURAL / INTRATHECAL ORDERS
1. Pre-hydrate patient with 500-1000 ml LR over 15-30 minutes.
2. This patient has received the following: (drug) (dosage)
(drug)
(dosage)
route of administration: epidural intrathecal at : AM / PM
3. Epidural infusion of: at ml / hour
4. Epidural bolus set at ml every minutes prn pain, to be pushed by patient / RN
5. Adjunctive medications:
A. naloxone (Narcan) 0.1 mg IV push q 3 hours prn itching
B. ondansetron (Zofran) 4 mg IV q 4 hours prn nausea; if no relief in 15 minutes, may give:
C. metoclopramide (Reglan) 10 mg IV q 6 hours prn nausea
D. Other:
6. No additional po, transdermal, sc, IM, or IV narcotics / sedatives to be given, except on order of anesthesiologist,
until epidural is discontinued.
7. Maintain intravenous infusion.
8. Monitoring: (unless otherwise ordered)
A. BP-P-RR q 5 minutes x 3, q 15 minutes x 3, q 30 minutes thereafter until epidural is discontinued
B. Respiratory depression or obtundation:
1) Notify anesthesiologist STAT if RR less than 10, or for any evidence of respiratory difficulty.
2) If severe respiratory depression (RR less than 8), apneic episodes, or cyanosis occur:
a. Administer naloxone (Narcan) 0.2 mg IV push and repeat every 60 seconds until RR is greater
than 10.
b. Administer oxygen by face mask or ambu bag as necessary.
C. Mental Status - If patient develops deterioration in mental status, call anesthesiologist STAT.
D. Call anesthesiologist if pain control is inadequate, patient has weakness or numbness greater than T6 (i.e.
breasts are numb), or for pump malfunction.
E. Monitor oxygen saturation prn.
F. Do NOT "flush" epidural catheters.
9. Keep oxygen flow meter, resuscitation bag with face mask & connecting tubing, and wall suction set up with
Yankauer suction, at bedside.
10. Discontinue infusion at delivery or by request of obstetrician.
NURSE’S
INITIALS
FORM 322-0521 Rev. 11/09
LABOR EPIDURAL / INTRATHECAL ORDERS