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FAMILY EXAM #2
Pain Management, Cultural Considerations, Patient Education
| Question | Answer |
|---|---|
| SYSTEMIC ANALGESIA | Pain relief can occur within minutes and lasts for several hours. Most serious complication includes respiratory depression. |
| NEURAXIAL ANALGESIA / ANESTHESIA | Is the administration of analgesic (opioids) or anesthetic (capable of producing a loss of sensation in an area of the body) agents, either continuously or intermittently, into the epidural or intrathecal space to relieve pain. It does not interfere with the progress or outcome of the labor. There is no need to withhold until the active stage of labor. Can include low-dose and ultra-low-dose epidural analgesia, spinal analgesia, and combined spinal-epidural. |
| BENZODIAZEPINES | Used for minor tranquilizing and sedative effects. Can be administered to calm the mother who feels out of control, enabling relaxation. May cause CNS depression for both the woman and the newborn |
| DIAZEPAM (VALIUM) | Given to enhance pain relief of opioid and cause sedation. May be used to stop eclamptic seizures, decreases nausea and vomiting. Can cause newborn depression, so the lowest possible dose should be given. Given IV |
| MIDAZOLAM (VERSED) | Not used for analgesic but for amnesia. Is used as adjunct for anesthesia. Is excreted in breastmilk. Given IV |
| ANTIEMETICS | May be given in combination with an opioid to decrease nausea and vomiting and lessen anxiety. Potentiate the effectiveness of the opioid so that a lesser dose can be given. Does not affect the progress of labor, but can cause a decrease in FHR variability and possible newborn depression |
| HYDROXYZINE (VISTARIL) | Does not relieve pain, but reduces anxiety, and potentiates opioid analgesic effects. Cannot given IV. Decreases nausea and vomiting. Can only be given IM |
| PROMESTHAZINE (PHENERGAN) | Used for nausea and vomiting when combined with opioids. Causes sedation and reduces apprehension. May contribute to maternal hypotension and neonatal depression. Can be given IV or IM |
| PROCHLORPERAZINE (COMPAZINE) | Frequently given with morphine sulfate for sleep during prolonged latent phase. Counteracts the nausea that opioids cause. Can be given IV or IM |
| MORPHINE | Decreases uterine contractions. Can cause maternal and neonatal CNS depression. Rapidly crosses the placenta. Causes a decrease in FHR variability. May be given IV or epidurally |
| MEPERIDINE (DEMEROL) | Can cause CNS depression. Decreases fetal variability. May be given IV, intrathecally, or epidurally with maximal fetal uptake 2-3 hours after administration |
| BUTORPHANOL (STADOL) | Rapidly transferred across the placenta. Causes neonatal respiratory depression. Is given IV |
| NALBUPHINE (NUBAIN) | Causes maternal nausea and vomiting. Causes decreased FHR variability, fetal bradycardia, and respiratory depression. Is given IV |
| FENTANYL (SUBLIMAZE) | Can cause maternal hypotension, maternal and fetal respiratory depression. Rapidly crosses the placenta. Is given IV or epidurally. |
| HYDROTHERAPY | External use of any form of water for health promotion. May involve showering, soaking in a regular tub, or whirlpool. Benefits include reducing pain, reliving anxiety, and promoting a sense of control. Risks include hyperthermia, hypothermia, changes in maternal HR, fetal tachycardia, or unplanned water birth |
| HEAT & COLD | Easy to use, inexpensive, and have minimal side effects when used properly. Can also be used to relieve chills, trembling, decrease joint stiffness and muscle spasms. |
| EFFLEURAGE | Light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions. Used as a relaxation and distraction technique from discomfort. External fetal monitor belts may interfere with the ability to accomplish this |
| MASSAGE | Works as a form of pain relief by increasing the production of endorphins in the body, which reduce the transmission of signals between nerve cells and thus lower the perception of pain. |
| POSITION & AMBULATION | Influenced by cultural factors, obstetric practices, place of childbirth, technology, and preferences of mothers and caregivers. It is recommended to change position every 30 minutes or so, sitting, walking, kneeling, standing, lying down, getting on hands and knees, and using birthing ball. This can also help speed labor by adding the benefits of gravity and changing the shape of the pelvis. |
| CONTROLLED BREATHING | Helps reduce pain experienced by using stimulus-response conditioning. The mother selects a focal point within her environment to stare at during the first sign of a contraction (which creates a visual stimulus that goes directly to her brain). The woman takes a deep cleansing breath, which is followed by rhythmic breathing. |
| GENERAL NUTRITION RECOMMENDATIONS – POSTPARTUM WOMEN | Eat a wide variety of foods with high nutrient density. Eat meals that require little or no preparation. Make sure all foods are well-cooked to prevent bacteria ingestion. Avoid high-fat fast foods. Drink plenty of fluids daily—at least 2,500 mL (approximately 84 oz). Avoid fad weight-reduction diets and harmful substances such as alcohol, tobacco, and drugs. Avoid excessive intake of fat, salt, sugar, and caffeine. Eat the recommended daily servings from each food group |
| NUTRITION RECOMMEDATIONS FOR THE BREAST-FEEDING MOTHER | Calories: +500 cal/day for the first and second 6 months of lactation. Protein: +20 g/day, adding an extra 2 c of skim milk Calcium: +400 mg daily—consumption of four or more servings of milk. Iodine: 290 μg daily—dairy products, seafood and iodized salt. Fluid: +2 to 3 qt of fluids daily (milk, juice, or water); no sodas |
| ATTACHMENT STAGES | PROXIMITY, RECIPROCITY, COMMITMENT |
| COMMITMENT | Refers to the enduring nature of the relationship. It is twofold: Centrality and parent role exploration |
| RECIPROCITY | The process by which the infant's abilities and behaviors elicit parental response. Parents who become skilled at recognizing the ways their infant communicates will respond appropriately by smiling, vocalizing, touching, and kissing. It has two dimensions: complementary behavior and sensitivity |
| PROXIMITY | Refers to the physical and psychological experience of the parents being close to their infant. Includes contact, emotional state, and individualization |
| CENTRALITY | Parents place the infant at the center of their lives. They acknowledge and accept their responsibility to promote the infant's safety, growth, and development |
| PARENT ROLE EXPLORATION | The parent's ability to find their own way and integrate the parental identity into themselves |
| SENSITIVITY | Parents who are sensitive and respond to their infant's cues will promote their development and growth |
| COMPLEMENTARY BEHAVIORS | Involve taking turns and stopping when the other is not interested or becomes tired. An infant can coo and stare at the parent to elicit a specific parental response to complement their behavior. |
| INDIVIDUALIZATION | parents are aware of the need to differentiate the infant’s needs from themselves and to recognize and respond to them appropriately, making the attachment process, in a way, one of detachment |
| EMOTIONAL STATE | emerges from the affective experience of the parents toward their infant and the parental role |
| CONTACT | is the sensory experiences of touching, holding, and gazing at the infant |
| MATERNAL PSYCHOLOGICAL CARE | Provide time for skin-to-skin contact as it is proven to have a positive impact on the long-term health of both mother and baby |
| PARTNER PSYCHOLOGICAL CARE | Keep them informed about birth and postpartum routines. Report on their newborn's health status, and reviewing infant development. They also can create participative space for new partners during postpartum periods |
| TAKING-IN PHASE | Typically, immediately after birth when the mother needs sleep, depends on others to meet her needs, and relives events surrounding the birth process. Characterized by dependent behavior and allows the nurses to make decisions for them regarding activities and care. Often interacts with the newborn by claiming them, touching them, and identifying common features in the newborns (such as “she has my nose”) |
| TAKING-HOLD PHASE | Typically begins on the second to third day postpartum and lasts several weeks. Characterized by dependent and independent maternal behavior. Expressed concerns own health, infants' condition, and her ability to care for them. strong interest in caring for them herself. Desire to take charge with help from others, shows. Independence by caring for herself and learning to care for her newborn. Still requires assurance that she is doing well. |
| LETTING-GO PHASE | Reestablishing relationships with others, Adapts to parenthood and assumes the responsibility and care of the newborn with confidence. Focuses on moving forward by assuming the parental role and to separate herself from symbiotic relationship that she and her newborn had during pregnancy. Establishes a lifestyle that includes the infant, and relinquishes the fantasy infant and accepts the real one |
| BOTTLE & BREAST FEEDING | All infants whether breast or bottle fed receive a daily supplement of 400 IU of vitamin D starting within the first few days of life to prevent rickets and vitamin D deficiency. Newborns swallow air during feedings which can lead to discomfort and fussiness, to prevent this parents should burp them frequently throughout the feeding. Encourage them to hold their baby comfortable, maintain eye contact, and talk softly during feeding to promote closeness and security |
| MECONIUM | passed for the first 48 hours after birth and will appear thick, tarry, sticky, and dark green |
| TRANSITIONAL STOOL | thin, brown to green, less sticky than meconium, and typically appears on day 3 |
| BREASTFED STOOL | mustard-colored, soft stool with a seedy consistency |
| FORMULA FED STOOL | yellow to brown, soft stools with a pasty consistency |
| CIRCUMCISION CARE | Should be at least 12 hours old, received vitamin K, voided at least once, not eaten in an hour, written parental consent. Tip should be covered with petroleum Jelly and gauze to prevent sticking, Iwith every diaper change. Assess for bleeding every 30 mins,edema document first voiding. Squeeze soapy water over area daily, rinse with warm water and pat dry. Fasten diaper loosely over penis, avoid placing on abdomen to prevent friction |
| GENERAL SAFETY CONCERNS | Have safety numbers handy, safety outlet plugs, do not leave in room without monitor, avoid placing crib and changing table near blinds or curtain rodes, place on back to sleep, never leave alone on elevated surface. Use sunshields on strollers, and hats. Always wash hands before preparing formula |
| CORD CARE | The cord begins drying within hours after birth and is shriveled and blackened by the second or third day. Within 7-10 days it sloughs off and the umbilicus heals. During the transition, frequent assessments of the area are necessary to detect any bleeding or signs of infection. Avoid tub baths until cord falls off and area heals, expose to free air. Never pull or attempt to loosen. For males point the penis down to prevent urine from wetting the top of the diaper |
| BATHING | Should be done with wiping the eyes with plain water from inner corner to outer. Then wash the rest of the face, ears, with plain water. Using shampoo gently wash hair and rinse with water. Pay special attention to creases and dry thoroughly. Wash extremities, trunk, back. Wash, rinse, dry, cover. Wash diaper area last using soap and water |
| Prevent abductions | Parents and nurses must work together to prevent infant abductions. Parents must know how to identify hospital staff, and nurses should be alert for suspicious behavior |
| Vietnamese Cultural Considerations | COLD STAGE (DUONG). view the postpartum period as a cold state (duong) and protect themselves with warmth. Cultural practices include warm water for hygiene and stimulation of lactation, consuming warm foods, and staying indoors |
| Somali Cultural Considerations | High regarded in society for their roles as mothers. The postpartum mother stay at home and refrain from sexual activity for 40 days. At the end of the 40 days, there is a celebration, and this typically marks the first time the mother and infant have left the home since birth. |
| Latin American, African, & Asian Cultural Considerations | Hot & Cold Practices are considered harmful |
| Chinese Cultural Considerations | Childbearing and postpartum are viewed as states that disturb the normal health balance between ying and yang. To restore balance, the women engage in practices for a month related to the maternal role. Physical activity, maintenance of body warmth, and certain food consumptions that will restore balance |
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