CH 13: Pain Management during Childbirth Flashcards
- Childbirth preparation can be considered successful if which of the following outcomes is achieved?
a.
Labor was pain-free.
b.
The birth experiences of friends and families were ignored.
c.
Only nonpharmacologic methods for pain control were used.
d.
The patient rehearsed labor and practiced skills to master pain.
ANS: D
Preparation allows the woman to rehearse for labor and to learn new skills to cope with the pain of labor and the expected behavioral changes. Childbirth preparation does not guarantee a pain-free labor. A woman should be prepared for pain and anesthesia–analgesia realistically. Friends and families can be an important source of support if they convey realistic information about labor pain. Women will not always achieve their desired level of pain control by using nonpharmacologic methods alone.
- A woman with a known heroin habit is admitted in early labor. Which drug is contraindicated with opiate-dependent patients?
a.
Nalbuphine (Nubain)
b.
Hydroxyzine (Vistaril)
c.
Promethazine (Phenergan)
d.
Diphenhydramine (Benadryl)
ANS: A
Nalbuphine may precipitate withdrawal if given to an opiate-dependent woman. Hydroxyzine is an antihistamine with antiemetic effects. Promethazine usually relieves nausea and vomiting. Diphenhydramine is commonly used to relieve pruritus from epidural narcotics.
- A patient is admitted to the labor and birth room in active labor; contractions are 4 to 5 minutes apart and last for 30 seconds. The nurse needs to perform a detailed assessment. When is the best time to ask questions or perform procedures?
a.
After the contraction is over
b.
When it is all right with the coach
c.
During the increment of the next contraction
d.
After administration of analgesic-anesthetic
ANS: A
Reduce intrusions as much as possible. Longer assessments may span several contractions. The coach is the support person. The woman needs to feel confident in her ability to go through labor and birth, and she should be encouraged to express her own needs and concerns. The increment is the beginning of the next contraction. It is best to stop with questions and procedures during each contraction. An analgesic or anesthetic may cause adverse reactions in the woman, preventing her from answering questions correctly.
- Childbirth pain is different from other types of pain in that it is
a. less intense.
b.
associated with a physiologic process.
c.
more responsive to pharmacologic management.
d.
designed to make one withdraw from the stimulus.
ANS: B
Childbirth pain is part of a normal process, whereas other types of pain usually signify an injury or illness. Childbirth pain is not less intense than other types of pain. Pain management during labor may affect the course and length of labor. The pain with childbirth is a normal process; however, it is not caused by the type of injury as when withdrawal from the stimulus occurs.
- Excessive anxiety during labor heightens the patient’s sensitivity to pain by increasing
a.
muscle tension.
b.
the pain threshold.
c.
blood flow to the uterus.
d.
rest time between contractions.
ANS: A
Anxiety and fear increase muscle tension, diverting oxygenated blood to the woman’s brain and skeletal muscles. Prolonged tension results in general fatigue, increased pain perception, and reduced ability to use coping skills. Anxiety will decrease the pain threshold. Anxiety can decrease blood flow to the uterus. Anxiety will decrease the amount of rest the mother gets between contractions.
- Which fetal position may cause the laboring patient increased back discomfort?
a.
Left occiput anterior
b.
Left occiput posterior
c.
Right occiput anterior
d.
Right occiput transverse
ANS: B
In the left occiput posterior position, each contraction pushes the fetal head against the mother’s sacrum, which results in intense back discomfort. Back labor is seen mostly when the fetus is in the posterior position.
- A major advantage of nonpharmacologic pain management is
a.
a more rapid labor is likely.
b.
more complete pain relief is possible.
c.
the woman remains fully alert at all times.
d.
there are no side effects or risks to the fetus.
ANS: D
Because nonpharmacologic pain management does not include analgesics, adjunct drugs, or anesthesia, it is harmless to the mother and the fetus. There is less pain relief with nonpharmacologic pain management during childbirth. Pain management may or may not alter the length of labor. At times, when pain is decreased, the mother relaxes and labor progresses at a quicker pace. The woman’s alertness is not altered by medication, but the increase in pain will decrease alertness.
- The best time to teach nonpharmacologic pain control methods to an unprepared laboring patient is during which stage?
a.
Latent phase
b.
Active phase
c.
Second stage
d.
Transition phase
ANS: A
The latent phase of labor is the best time for intrapartum teaching because the woman is usually anxious enough to be attentive yet comfortable enough to understand the teaching. During the active phase, the woman is focused internally and unable to concentrate on teaching. During the second stage, the woman is focused on pushing. She normally handles the pain better at this point because she is active in doing something to hasten the birth. During transition, the woman is focused on keeping control; she is unable to focus on anyone else or learn at this time.
- The primary side effect of maternal narcotic analgesia in the newborn is
a.
tachypnea.
b.
bradycardia.
c.
acrocyanosis.
d.
respiratory depression.
ANS: D
An infant delivered within 1 to 4 hours of maternal analgesic administration is at risk for respiratory depression from the sedative effects of the narcotic. The infant who is having a side effect to maternal analgesics normally would have a decrease in respirations, not an increase. Bradycardia is not the anticipated side effect of maternal analgesics. Acrocyanosis is an expected finding in a newborn and is not related to maternal analgesics.
- The nerve block used in labor that provides anesthesia to the lower vagina and perineum is referred to as a(n)
a.
local.
b.
epidural.
c.
pudendal.
d.
spinal block.
ANS: C
A pudendal block anesthetizes the lower vagina and perineum to provide anesthesia for an episiotomy and use of low forceps, if needed. A local provides anesthesia for the perineum at the site of the episiotomy. An epidural provides anesthesia for the uterus, perineum, and legs. A spinal block provides anesthesia for the uterus, perineum, and down the legs.
- The nurse is teaching a childbirth education class. Which information regarding excessive pain in labor should the nurse include in the session?
a.
It usually results in a more rapid labor.
b.
It has no effect on the outcome of labor.
c.
It is considered to be a normal occurrence.
d.
It may result in decreased placental perfusion.
ANS: D
When experiencing excessive pain, the woman may react with a stress response that diverts blood flow from the uterus and the fetus. Excessive pain may prolong the labor because of increased anxiety in the woman. It may affect the outcome of the labor, depending on the cause and the effect on the woman. Pain is considered normal for labor. However, excessive pain may be an indication of other problems and must be assessed.
- Which patient will most likely have increased anxiety and tension during labor?
a.
Gravida 2 who refused any medication
b.
Gravida 2 who delivered a stillborn baby last year
c.
Gravida 1 who did not attend prepared childbirth classes
d.
Gravida 3 who has two children younger than 3 years
ANS: B
If a previous pregnancy had a poor outcome, the patient will probably be more anxious during labor and birth. The patient without childbirth education classes is not prepared for labor and will have increased anxiety during labor; however, the patient with a poor previous outcome is more likely to experience a greater degree of anxiety. A gravida 2 has previous experience and can anticipate what to expect. By refusing any medication, she is taking control over her situation
and will have less anxiety. This gravida 3 has previous experience and is aware of what to expect.
- Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?
a.
Narcotics
b.
Spinal block
c.
Epidural anesthesia
d.
Breathing and relaxation techniques
ANS: D
Nonpharmacologic methods of pain management may be the best option for a woman in advanced labor. At 8 cm cervical dilation there is probably not enough time remaining to administer spinal anesthesia or epidural anesthesia. A narcotic given at this time may reach its peak at about the time of birth and result in respiratory depression in the newborn.
- A laboring patient who imagines her body opening to let the baby out is using a mental technique called
a.
imagery.
b.
effleurage.
c.
distraction.
d.
dissociation.
ANS: A
Imagery is a technique of visualizing images that will assist the woman in coping with labor. Effleurage is self-massage. Distraction can be used in the early latent phase by having the woman involved in another activity. Dissociation helps the woman learn to relax all muscles except those that are working.
- When administering a narcotic to a laboring patient, which statement explains why the nurse should inject the medication at the beginning of a contraction?
a.
The medication will be rapidly circulated.
b.
Less medication will be transferred to the fetus.
c.
The maternal vital signs will not be adversely affected.
d.
Full benefit of the medication is received during that contraction.
ANS: B
Injecting the medication at the beginning of a contraction, when blood flow to the placenta is normally reduced, limits transfer to the fetus. It will not increase the circulation of the medication. It will not alter the vital signs any more than giving it at another time. The full benefit of the medication will be received by the patient.