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WVC OB Pain Manage
WVC OB Pain Management for Labor and Delivery
| Question | Answer |
|---|---|
| Two types of pain management techniques | pharmacological and non-pharmacological |
| What are the two components of pain | A physiologic component that includes reception by sensory nerves and transmission to the central nervous system and PSYCHOLOGICAL that involves interpreting the pain. |
| How is childbirth pain different from other pain? | Child birth pain is part of a process. Other pain is indication of injury or illness. There is time to prepare, it has a definite end, it is intermittent. |
| What is the major physiologic effect of labor pain and what negative effect does it have on the fetus? | Labor pain increases the mother's metabolic rate. If she breaths too fast Pao2 & PaCo2 can become unbalanced. This disrupts the exchange of placental oxygen and waste. The fetus then shifts to an anaerobic metabolisms. |
| What does high catecholamine levels do to the fetus? | They reduce blood flow to the uterus and placenta. The fetus is more likely to become HYPOXIC. Labor is slowed and becomes less productive. |
| What are the two types of pain? | Visceral and somatic |
| Pain that is slow, deep and poorly localized. It is described as dull or aching. This pain dominates the first stage of labor as the uterus contracts and the cervix dilates. | Visceral pain |
| Faster, sharp pain that is localized and is characteristic of end first stage labor and during second stage of labor. | Somatic pain is where the fetus puts direct pressure on the maternal tissues. |
| What are the four sources of pain during labor? | Tissue Ischemia Cervical Dilation Pressure and Pulling on Pelvic Structures Distention of the Vagina and Perineum |
| The intensity of labor can be influenced by stronger contractions. What are some of the reasons that would cause more intense contractions? | Dilation and effacement during pre-labor are incomplete, resulting in more contractions and longer labor. Also, a fetus that is in an unfavorable position will cause labor to be longer and more uncomfortable (back labor) |
| What can reduce a woman's ability to tolerate pain and to use relaxation techniques? | Fatigue |
| What magnifies sensitivity to pain? | Fear and anxiety |
| What are some of the psychosocial variables that influence a woman's experience of pain? | Culture influences how she tolerates pain, fear and anxiety, past experiences, preparation for childbirth and support system. |
| What is the best intrapartum time for a woman to learn non-pharm methods? | During the latent phase of labor because the woman is anxious, yet comfortable enough to understand. |
| What is the term used when non-pharm methods become less effective? | Habituation. It is the reason why a nurse should know a variety of non-pharm pain management methods. |
| What are the four categories that can be applied to intrapartum care? | Relaxation, cutaneous stimulation, mental stimulation and breathing. |
| What non-pharm technique provides the basis for all other methods of pain management? | Relaxation, because it promotes uterine blood flow, improving oxygenation, promotes efficient contractions, reduces tension that increases pain perception and inhibit fetal descent. |
| What are some nursing interventions that can improve relaxation? | Creating a comfortable environment, room temperature, reducing irritants (bright lights)and using music in the background for imagery and breathing techniques. |
| How can a nurse reduce anxiety and fear for a woman in labor? | By providing accurate information and focusing on the normality of the birth. |
| What are the various types of relation techniques? | Progressive relation, neuromuscular dissociation, touch relaxation & relaxation against pain. |
| Which fetal position creates sacral pain and what non-pharm technique is best used to combat it? | Lateral Occiput Posterior position. Sacral pressure with the palm of the hand can relieve some of this pain. |
| What are the types of cutaneous stimulation used? | self massage, massage by others, thermal stimulation and acupressure |
| What types of mental stimulation are there? | Imagery and focal point |
| Breathing in the FIRST STAGE of labor consists of a ___________ breath and various breathing techniques known as ___________ breathing. | Each contraction begins and ends with an inspiration and expiration CLEANSING BREATH, followed by various PACED breathing techniques. |
| If a woman pushes strenuously before the cervix is completely dilated, she risks injury to the cervix and the fetal head. What is a method used to control the urge to push? | The woman can blow using short puffs. Blowing prevents closure of the glottis and breath holding which are part of strenuous pushing. |
| What are some of the common problems associated with breathing techniques? | Hyperventilation and mouth dryness. |
| Breathing in the SECOND STAGE of labor is characterized by...? | No more than 3 to 4 sessions of breath holding lasting 6 to 8 seconds. |
| Why is it dangerous for a woman to hold her breath longer than 6 to 8 seconds during the second stage of child birth? | It can lower the woman's blood pressure and causes less blood to be delivered to the placenta. This can result in fetal hypoxia, reflecting in non-reassuring fetal heart patterns. |
| What are the normal physiologic changes that occur during pregnancy? | Cardiovascular: pressure on the inferior vena cava and aorta if the mom lies on her back. RESPIRATORY, reduced respiratory capacity, resulting in increased sensitivity to anesthesia. GI- Progesterone slows peristalis. NERVOUS system. |
| What is the effect on labor if analgesics are given too early in labor? | It can slow the contractions down resulting in slower progression in the second stage of labor. |
| The regional anesthetic pain management that is used only during birth are? | local, pudendal adn subarachnoid blocks |
| What are some of the adverse effects of an epidural block? | Maternal hypotension, usually occurs within the first 15 minutes, but sometimes can last up to 1 hour. Fetal: rising baseline FHR, tachycardia or late decelerations. Prolonged 2nd stage, movement of the catheter, fever. |
| What are some of the adverse effects of epidural opioids? | Nausea, vomiting, pruritus, and delayed respiratory depression. |
| How often is FHR and the mother's BP assessed after an epidural block? | Evidenced based practice suggests that BP and FHR are assessed against baseline every 5 mins after a block, for the 15 mins. |
| What are the most common drugs used in subarachnoid opioid analgesics? | fentanyl, sufentanil and morphine |
| What are the most common opioid analgesics? | Meperidine (Demerol), fentanyl (Sublimaze), butorphanol (Stadol), nalbuphine (Nubain) |
| What is the name of the drug that counteracts the effects of a narcotic? | Narcan, generic naloxone. |
| This block anesthetizes the lower vagina and part of the perineum. | Pudendal block is given for relief of episiotomy and vaginal birth. |
| What does a pain related assessment include? | preference on pain management previouse surgeries, anesthesia and assoc. problems, maternal vital signs, FHR & patterns, allergies, oral intake (type & time), subjective and objective evidence of pain. |
| What types of blocks are used for a cesarean? | epidural, the level of the block can be extended upward Subarachnoid, can be establish faster than an epi. General anesthesia. |
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