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OB test 3 chapter 17

Pain Management

Pain and discomfort of labor have two origins: Visceral and somatic
______ pain is caused by distention of the lower uterine segment stretching of cervical tissue pressure and traction of adjacent structures and nerves uterine ischemia during the first stage of labor. Visceral
Viseral pain is located here lower portion of the abdomen
pain that originates in the uterus radiates to the abdomen wall, lumbosacral area of the back, illiac crests, gluteal area, thighs, and lower back. referred pain
_______ pain is described as intense sharp burning and well localized. somatic pain
Type of pain felt in the first stage of labor visceral
Type of pain felt in the second stage of labor somatic
This type of pain is caused by the streching of the perineal tissues and pelvic floor, from distension and traction of the peritoneum and uterocervical supports, from pressure against the bladder and rectum, and from lacerations of soft tissue. somatic
Pain impulses during the second stage of labor are transmitted through the pudendal nerve
The meaning of pain and the verbal and non-verbal expressions are learned from interactions within the primary social group
The level of pain a laboring woman is willing to endure pain tolerance
Factors that influence pain tolerance and request of meds include: desire for a natural vag delivery childbirth preparation support during labor willingness and ability to participate in non pharm measures for comfort
_____ and ______ are common in the active and transition phases of the first stage of labor Nausea and Vomiting
Maternal respiratory pattern changes related to increased _________________ o2 consumption
These are endogenous opoids secreted by the pituitary gland that act on the CNS and PNS to reduce pain endorphins
Edorphins are associated with feelings of ________ and __________. euphoria and analgesia
As endorphin levels rise during labor, __________ may increase. pain tolerance
This is associated with increased pain during labor anxiety
excessive _______ and _______ magnifies pain perception anxiety and fear
increased anxiety and fear causes increased _________, effectiveness of contractions __________, discomfort _________ and a cycle of _________ fear and anxiety being. Which slows the progess of labor. muscle tension decrease increases increased
_________ magnifies pain fatigue
________ and ________ techniques are forms of care that are effedtive to some degree in releiving labor pain. attention-focusing and distraction
a woman focuses her attention on a pleasant scene, a place where she feels relaxed, or an activity she enjoys imagery
this is performed at approximately half the womans normal resp rate and is initiated when she can no longer walk to talk through contractions slow-paced breathing (6-8 bpm,no fewer than 3-4 bpm)
This respiratory pattern is shallower and faster than the womans normal resp rate, but should not exceed 2x her normal rate modified-paced breathing (32-40 bpm)
Relaxed breath in through the nose and out through the mouth. Used at the beginning and end of each contraction. cleansing breath
The most difficult time to maintain control during contractions comes during the ________ phase of the ________ stage of labor, when the cervix dialates from ____ cm to _____ cm. _________ breathing is suggested during this phase. transition first 8 10 patterned-paced (pant-blow)
This breathing patteren consists of panting breaths combined with soft blowing breaths at regular intervals patterned-paced
light stroking, usually of the abdomen, in rhythm with breathing during contractions. (thigh or chest may be used if monitor attached to abd) Effleurage
steady pressure that is applied by a support person to the sacral area with a firm object. Pressure can also be applied to the hips and knees. counterpressure
This stimulates the release of endorphons, relaxes fibers at the gate on pain, promotes better circulation and oxygenation and helps to soften the perineal tissues warm water (hydrotherapy)
Women in labor often report that pain and discomfort ______ while in water subside
Hydrotherapy is usually initiated when the woman is in __________, at approximately 5 cm. active labor
assuming _____ and ______ position or a ________ lying position in the tub enhances spontaneous fetal rotation to the OA position as a result of increased buoyancy hands and knees side lying
placement of _________ is contraindicated for jet hydrotherapy. internal electrodes
during hydrotherapy the temp of the water should stay between _____ and _____ with the water covering the womans abd and shoulders uncovered to dissipate heat 36C-37C
Because warm water can cause dizziness, a shower stool should be used and the woman should be assisted when getting in and out of the tub. SAFETY ALERT
The placing of two pairs of flat electrodes on either side of the womans thoracic and sacral spine TENS
accupressure points tsubos
Accupressure points are found: neck shoulders wrists lower back hips area below the kneecaps ankles nails on the small toes soles of feet
insertion of fine needles into specific areas of the body to restore flow of energy and decrease pain. accupuncture
______ relieves muscle ischemia and increases blood flow to the area of discomfort heat therapy
_____ relieves pain by reducing the muscle temp and relieving muscle spasms cold therapy
______ and _____ should never be applied over ischemic or anesthetized ares because tissues can be damaged and one or two layers of cloth should be placed in between the skin and heat/cold to prevent damage. heat and cold therapy
Therapeutic touch uses the concept of energy fields within the body called _______ which are thought to be deficient in people in pain. prana
_______ uses laying-on of hands to redirect energy fields associated with pain. Therapeutic touch
hyperesthesia causes a woman to become intolerable of touch during advanced labor.
The injection of small amounts of sterile water by using a fine needle in four locations on the lower back to relieve low back pain. Intradermal water block
The injections should raise a bled on the skin and simultaneous injections by two clinicians will decrease the pain of the injections. Intense stinging for about 20-30 seconds after procedure with pain relief for up to 2 hours. Intradermal water block NOTE
These are given to relieve anxiety and induce sleep. they are given to women expierencing prolonged labor when there is need to decrease anxiety or promote sleep Sedatives
______ may be give to augment analgesics and reduce nausea when an opiod is used. Sedatives
____________ should be avoided if birth is anticipated within 12 to 24 hours. (these are seldom used during labor) barbiturates
encompasses analgesia, amnesia, relaxation, and reflex activity. it abolishes pain perception by interrupting the nerve impulses to the brain. The loss of sensation may be partial or complete, sometimes with the loss of consciousness. anesthesia
the alleviation of the sensation of pain or the raising of the threshold for pain perception with out the loss of consciousness analgesia
_____ administration is perferred over _____. meds kick in faster and they are more predictable. IV IM
These have no amnesic effect but create a feeling of well being and enhance a womans ability to relax in between contractions, they should not be administered until labor is well established unless used to increase rest during a prolonged latent phase. opiod agonist
These are effective for relieving severe, persistant or recurrent pain by blunting the perception of the pain not eliminating it. (dilaudid, demerol) opiod agonist
Opioids decrease maternal heart and resp rate and BP which affects fetal oxygenation. maternal VS and FHT must be assessed and documented prior to and after administration. SAFETY ALERT
Birth should occure less than _____ or more than ____ after administration of an __________ analgesic so that neonatal CNS depression is minimized. 1 hour 4 hours
an agent that activates or stimulates a receptor to act agonist
an agent that blocks a receptor or a med designed to activate a receptor antagonist
these mixed opioids provide adequate analgesia without significant resp depression in the mother and baby opioid agonist-antagonist
this classification of opioid analgesics is not suitable for women with an opioid dependency because they could precipitate withdrawl symptoms in both mom and baby. opioid agonist-antagonist
Anecdote for opioid agonist Naloxone
If birth occurs within 1-4 hours after administration of an opioid agonist-antagonist observe the newborn for respiratory depression SAFETY ALERT
Do not give this to a woman or newborn if the woman is opioid dependant- it may cause abrupt withdrawl narcan (Naloxone)
Opioid agonist-antagonist such as stadol and nubain should not be given to opioid dependant mothers because it may precipitate withdrawl symptoms SAFETY ALERT
these can reverse the CNS depressant effects of opioids. opioid antagonist
a state of CNS depression in the newborn produced by an opioid. neonatal narcosis
this may be used when an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia local perineal infiltration anesthesia
this is administered late in the second stage of labor and is useful if an episiotomy is to be performed or if foreceps or a vacuum extractor are to be used to facilitate birth. This can cause the bearing down reflex to be lessened or completely lost pudendal nerve block
The pudendal nerve block does not relieve pain stemming from the uterine contractions, it does relieve pain in the: lower vagina, the vulva, and the perineum
an anesthetic solution containing a local anesthetic alone or in combo with an opioid agonist. this is injected through the 3rd,4th, or 5th lumbar interspace into the subarachnoid space. spinal anesthesia (block)
these side effects may occur during spinal anesthesia Marked hypotension, impaired placenta perfusion, and an ineffective breathing pattern.
Before the induction of a spinal block maternal VS are assessed and a 20-30 min EFM strip is obtained and evaluated. a bolus of 500-1000cc of LR is administered 15-30 minutes before to decrease the potential for hypotension. NOTE
vasodilation with pooling of blood in the lower extremities which decreases cardiac output. sympathetic blockade
After spinal block initiated these are monitored and must be documented Q5-10m Maternal: HR BP and RR Fetal: HR and Pattern
Because the woman is unable to sense her contractions after spinal anesthesia, she must be: instructed when to bear down during a vaginal birth
s/s of maternal hypotension with decreased placental perfustion maternal hypotension <=100mmhg systolic fetal bradycardia absent or minimal FHR variability
Interventions for maternal hypotension with decreased placental perfusion lateral position, maintain IV hydration, administer o2 (nonrebreather @ 10-12L/min) elevate legs, notify PCP or anesthesia team, IV vasopressor if other stuff doesnt work, remain with patient, monitor VS FHT Q5m until stable or per order.
Postdural puncture headache is caused by Leakage of CSF from the site of puncture of the dura mater
assumming and _______ position triggers or intensifies the headache, whereas assuming a ______ position acheieves relief of a spinal headache upright; supine
Spinal headace: The resulting headache, auditory problems, and visual problems begin within ______ of the puncture and may persist for days or weeks. 48 hours/2 days
First treatment for spinal headache hydration and caffiene
this is the most rapid, reliable, and beneficial relief of a spinal headache blood patch
after a blood patch the woman should be instructed to avoid _____ or _____ for several days. Also to avoid taking analgesics that affect platelet aggregation like NSAIDS for 2 days, drink plenty of fluids. coughing or straining
injection is made between the fourth and fifth lumbar vertebrae epidural block
Epidural anesthesia effectively relieves pain caused by uterine contractions. For most women, however, it does not completely remove the pressure sensations that occur as the fetus descends into the pelvis NURSING ALERT
What is used to increase maternal blood pressure r/t epidural/ ephedrine and increased fluids
What must be monitored after an epidural that is not related to the VS of the mother (because the mother may not be aware of the changes in strength of the contractions or of the descent of the baby. FHR and pattern, contraction pattern, and progress in labor.
Contraindications to Epidural hypovolemia (or risk of) hypotension coagulopathy infection at injection site increased ICP allergy to drug refusal or inability to cooperate some cardiac conditions abnormal FHT that require immediate birth
Epidural block effects on newborn little or no lasting effect on the physiologic status of the newborn
When is general anesthesia used in L&D only if there are contraindications to a spinal or epidural or when immediate birth is necessary and there is not enough time or staff to perform a block
Prior to the induction of anesthesia how much o2 should a patient get, by what mode and for how long? 100% o2 by non-rebreather mask for 2-3 minutes
this maneuver blocks the esophagus and prevents aspiration should the woman vomit or regurgitate cricoid pressure
Created by: 1272858662