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BSN 346 Nrs Conc III
Max Cmfrt for Laboring woman
| Question | Answer |
|---|---|
| Q: What is labor? | A: Labor is a series of progressive uterine contractions that result in dilation and thinning of the cervix, allowing the fetus to descend through the birth canal and be born. |
| Q: What are three key characteristics of labor pain from a physiological standpoint? | A: Labor pain is normal and anticipated, it is intense but time-limited, and it ends with the birth of the child. |
| Q: What are the two main types of pain during labor and when do they occur? | Visceral pain: Mostly in the first stage, due to uterine contractions, cervical dilation, and pressure on pelvic structures. Somatic pain: Later in the first stage and second stage, due to intense contractions and fetal descent pressing on maternal tissu |
| Q: What can poorly managed pain after labor result in? | A: It can lead to post-labor fatigue and exhaustion, making it difficult for the mother to interact with her newborn. |
| Q: Name cognitive non-pharmacological methods for managing labor pain. | A: Continuous labor support, music therapy, relaxation techniques, guided imagery, and breathing exercises. |
| Q: Name cutaneous non-pharmacological methods for managing labor pain. | A: Back, shoulder, or sacral massage; use of a birthing ball; and hydrotherapy. |
| Q: What systemic analgesics are used for labor pain? | A: IV full opioid agonists (fentanyl, remifentanil) and partial opioid agonists (butorphanol, nalbuphine). |
| Q: What are the types of regional analgesia used in labor? | A: Epidural, spinal, combined epidural-spinal, and pudendal block. |
| Q: What are two other pharmacological methods for labor pain management? | A: Intermittent inhalation of nitrous oxide and general anesthesia (mainly for cesarean delivery). |
| Q: What should nurses assess regarding pain management in labor? | A: The client’s knowledge of pain management options, preferences, and their coping ability during labor. |
| Q: What are signs a client is coping with labor pain? | A: Relaxing between contractions and being inwardly focused. |
| Q: What are signs a client is not coping? | A: Wincing, tense, and unable to focus. |
| Q: What nursing interventions help reduce anxiety during labor? | A: Speaking calmly and confidently, providing updates, adjusting the environment (lights, temperature), and maintaining cleanliness. |
| Q: What should client and family education about labor pain management include? | A: Explanation of both non-pharmacological and pharmacological methods, their effectiveness, effects on the fetus and newborn, and client participation in pain management decisions. |
| Q: What are the main categories of labor pain management? | A: Non-pharmacological (cognitive and cutaneous) and pharmacological (systemic analgesics, regional anesthesia, nitrous oxide, general anesthesia). |
| Q: What are analgesics and how are they used in obstetrics? | A: Analgesics are medications used to relieve pain. In obstetrics, they manage pain during pregnancy (e.g., headaches, back, pelvic pain), during delivery (uterine contractions, cervical stretching, vaginal distension), and after delivery (perineal lacera |
| Q: Which analgesics are commonly used in obstetric settings? | A: Acetaminophen (mainly during pregnancy), systemic analgesics like opioids, and regional analgesics like local anesthetics (typically once labor begins). |
| Q: Which analgesics should be avoided during pregnancy and why? | A: NSAIDs (e.g., ibuprofen) should be avoided because they can cause fetal harm, including fetal renal impairment, oligohydramnios, and premature closure of the ductus arteriosus. |
| Q: Name examples of full and partial opioid agonists, and regional anesthetics used in obstetrics. | A: Full opioid agonists: fentanyl, remifentanil; partial opioid agonists: butorphanol, nalbuphine; regional anesthetics: bupivacaine, ropivacaine. |
| Q: How do opioids and regional anesthetics relieve pain? | A: Opioids act on mu, kappa, and delta receptors in the spinal cord and brain to decrease pain sensitivity. Regional anesthetics block sodium channels on neurons, preventing pain transmission. |
| Q: How are opioids commonly administered in obstetric care? | A: Orally, intramuscularly, and intravenously. |
| Q: What is pudendal anesthesia and neuraxial anesthesia? | A: Pudendal anesthesia is local anesthetic injection to numb the lower vagina, vulva, and perineum. Neuraxial anesthesia is the injection of opioids and local anesthetic into the epidural or subarachnoid space for broader pain relief. |
| Q: What are common side effects of opioid analgesics in obstetric care? | A: Respiratory depression, nausea, vomiting, constipation, pruritus, hypotension, sedation, euphoria, confusion, decreased uterine contractions, fetal bradycardia, reduced fetal heart rate variability, and neonatal hypotonia. |
| Q: What are common side effects of regional anesthetics (epidural/spinal)? | A: Accidental spinal cord injury, motor weakness, infection, maternal hypotension (reducing placental blood flow), fetal asphyxia, high regional block (respiratory depression), headache, and risk of cardiac arrest with systemic toxicity. |
| Q: When are most analgesics avoided in pregnancy and why? | A: After the first trimester until labor begins, to minimize fetal risk. |
| Q: What is neonatal abstinence syndrome and when are opioids contraindicated? | A: Neonatal abstinence syndrome is withdrawal in newborns from prolonged maternal opioid use. Opioids are contraindicated in clients with respiratory disorders (e.g., asthma) and should not be combined with CNS depressants. |
| Q: When are local anesthetics contraindicated in obstetric care? | A: In clients with bleeding disorders or skin infection at the catheter insertion site. |
| Q: What is the nurse’s primary goal in managing pain for laboring clients? | A: To safely manage pain and minimize harmful effects such as anxiety, decreased fetal oxygen, and uncoordinated uterine contractions. |
| Q: What should be assessed before administering analgesics in labor? | A: Baseline uterine activity, fetal heart rate (FHR), FHR variability, accelerations/decelerations, baseline vital signs, SpO2, pain rating, and pain tolerance. |
| Q: What are important considerations when administering opioids during labor? | A: Administer after a pattern of contractions is established, educate the client that opioids blunt but do not eliminate pain, may cause sedation, and avoid administration within 1–4 hours of expected delivery to reduce neonatal respiratory depression. |
| Q: What should the nurse monitor after opioid administration? | A: Pain levels, tolerance, respiratory rate (hold if <12/min), nausea, vomiting, and manage side effects as ordered. |
| Q: What are key nursing actions before epidural anesthesia? | A: Ensure informed consent, review labs (hemoglobin, hematocrit, platelets, coagulation), establish IV access, and administer IV crystalloid bolus. |
| Q: How should the client be positioned for epidural catheter placement and what should be monitored? | A: Seated or lateral with back curved outward; monitor blood pressure, oxygen saturation, and fetal heart rate. |
| Q: What are signs of a high regional block during epidural anesthesia? | A: Dyspnea, bradycardia, weakness or numbness of upper extremities, and altered consciousness. |
| Q: What should the nurse do if maternal hypotension or fetal bradycardia occurs after epidural? | A: Initiate intrauterine resuscitation: IV fluid bolus, oxygen via nonrebreather (8–10 L/min), stop oxytocin, notify anesthesia provider, and prepare to administer ephedrine. |
| Q: What ongoing assessments are needed for clients with epidural analgesia? | A: Pain perception, sensory block level, motor function, SpO2, consciousness, FHR, uterine activity, labor progression, and catheter site. |
| Q: Why might an indwelling urinary catheter be needed with epidural anesthesia? | A: Epidural can interfere with the client’s ability to empty her bladder. |
| Q: What are the nurse’s responsibilities when administering analgesics in obstetric care? | A: Safely administer/assist with analgesics, monitor for side effects, and continually assess maternal and fetal well-being. |
| system analgesics (2 kinds of opioids) | full opioid agonists partial opioid agonists |
| full opioid agonists | fentanyl remifentanil |
| partial opioid agonists | butorphanol nalbuphine |
| regional anesthetics (local anesthetics) | bupivacaine ropivacaine |
| P,A.I.N. | purposeful (in order to birth the baby), anticipated (labor is not a pain-free experience), intermittent (contractions come and go as labor progresses), and normal (labor is not a pain-free experience). |
| Which physiologic effect results from labor pain?! Decreased metabolic rate Increased uterine blood flow Decreased maternal demand for oxygen Increased production of catecholamines | Increased production of catecholamines The production of “fight-or-flight” hormones increases as a result of labor pain and anxiety. These include the catecholamines epinephrine and norepinephrine. |
| Which event results in a somatic pain response during labor? Effacement of the cervix during early labor Dilation of the cervix during labor Bladder pressure Delivery of the fetal head | Delivery of the fetal head Delivery of the fetal head causes the perineum to stretch. Delivery of the fetal head results in a somatic pain response caused by the burning experienced at the perineum during the delivery of the fetal head. |
| A laboring patient places a cool, damp compress over her forehead. This is an example of which nonpharmacologic method of pain relief? Massage Acupressure Hydrotherapy Thermal stimulation | Thermal stimulation Placing a cool, damp compress over the head is an example of thermal stimulation. The laboring woman may place it on her head, throat, or abdomen, particularly if she feels overheated. Another example of thermal stimulation is a warm, |
| A woman is experiencing intense pain with each contraction during labor. Her partner asks her to describe in detail her favorite beach. Which relaxation technique is her partner using? Imagery Focal point Acupressure Thermal stimulation | Imagery |
| Which factors could improve a woman’s experience with pain during labor? Select all that apply. Cultural factors Financial factors Environmental factors Psychological factors Physiologic factors | Cultural factors Environmental factors Psychological factors Physiologic factors |
| A laboring patient reports moderate back pain. Her partner rubs her lower back and reminds her to look at the teddy bear they bought for the newborn. Which relaxation techniques are being used? Select all that apply Massage Focal point Hydrotherapy Ac | massage focal point |
| When teaching a childbirth class for first-time parents, the nurse includes which benefits of breathing techniques used during labor? Select all that apply Decreases sensation of pain Requires increased energy with continued use Provides a different f | decreases sensation of pain provides different focus during contractions can also substitute for pharmacologic therapies can be used with other nonpharmacologic techniques |
| Which situation demonstrates how an environmental factor could negatively affect a woman’s experience of pain during labor? The woman experienced tearing of the perineum during delivery. The woman had a complicated delivery with her previous child. The | The woman has no support at her bedside. |
| A laboring woman wishes to labor in the shower to alleviate pain. Which nonpharmacologic pain relief method is she applying? Massage Acupressure Hydrotherapy Relaxation | Hydrotherapy |
| The nurse is instructing a childbirth class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths/min. What should the patient’s rate be while performing slow-paced breathing techniques? 9 breaths/min 11 breaths | 11 breaths/min |
| The nurse is caring for a woman in the second stage of labor whose contractions have become more intense. What actions could the nurse take to assist this woman? Select all that apply. Model modified-paced breathing. Model slow-paced breathing. Monitor | Model modified-paced breathing. Model slow-paced breathing. Monitor for hyperventilation. Ask the patient if it is OK to hold her hand. |
| Which statement regarding pain experienced during labor is accurate? The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. Referred pain is the extreme discomfort between contractions. | The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. |
| Which information would the nurse consider when educating patients and support people about nonpharmacologic pain management techniques? Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital ro | Acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain. |
Created by:
adricela55