Analgesia L5 Flashcards
assessing pain in labor
assess pain regularly and with non-pharmacological and pharmacological interventions
what can anxiety and fear of the unknown do to a patients perceived pain?
may heighten their level of pain
how do you assess pain during labor?
on a scale of 0-10 during and between contractions
previous childbirth or surgeries can lead to what?
higher levels of concern about pain management
what kind of classes can aid in the ability to cope with U/Cs?
childbirth classes
non-pharmacological pain management in the latent first stage of labor:
1) focal point
2) massage/counterpressure
3) hydrotherapy/aromatherapy
4) music
5) breathing technique
6) TENS
7) heat/cold packs
8) hypnosis
9) changing positions/walk/rocker/birthball
10) sacral pressure/hip squeeze (when baby descends)
why should pain medication be discouraged in the first stage of labor?
they may slow the labor process
pain medications that can be used in the latent first stage of labor:
1) morphine sleep - promethazine and morphine (not evidence based)
2) Percocet
3) Benadryl
4) Norco
5) acetaminophen
usually PO
what are some pain medications not typically given in the latent phase of stage one labor?
1) epidural
2) NO2
pain management in the active phase of stage 1 labor:
1) may use non-pharm interventions from latent phase
if pain is intense pt can request IV meds
2) acetaminophen
3) fentanyl
4) nubian, demerol (1-4hrs)
5) stadol
6) may request epidural
7) NO2
why cant we give fentanyl in the second stage of labor?
risk for respiratory depression in neonate
why is it difficult to get an epidural in the second stage of labor?
pt may not be able to sit for the procedure
can epidural pump be on during second stage of labor?
yes if pt pushing efforts are effective, the epidural pump can stay on
why might a pt get local anesthesia in labor?
- for an episiotomy cut
- for repair of episiotomy or laceration
pudendal block
relieves pain in the vagina, vulva, and perineal regions
rarely used
can NO2 be used in the second stage of labor?
yes
in the third stage what analgesia is used if the placenta is retained?
1) may receive IV pain meds - fentanyl
2) may be moved to OR for twilight sleep
meds given for pain management during laceration/episiotomy repair:
1) local anesthesia (lidocaine)
2) epidural top-off
3) pudendal block (less common)
physiological adverse effects of excessive pain in labor:
1) slowed cervical change
2) pt can become tense
3) dehydration
4) inability to relax back muscles and do deep breathing
effects of excessive pain on cervical change:
1) increased pain = decreased ability to relax
2) reduced labor progression
factors that affect pain perception:
1) age (teens and older primigravidas)
2) culture/religion
3) previous experiences with pain
4) support person availability
5) fetal position
what fetal positions can increase pain?
OP fetal lies
nursing considerations related to analgesia and labor?
1) pain meds cross placenta (we dont want baby with respiratory depression)
2) some meds can slow labor progress
3) N&V
4) hypotension (can cause fetal intolerance of labor
5) NPO or no solids with epidural/prior to anesthesia
what labor analgesia meds can cause hypotension?
epidurals and spinals
