ch 14 Flashcards
visceral pain
- from cervical changes, distention of lower uterine segment, and uterine ischemia
- Located over lower portion of abdomen
- referred pain
- during first stage of labor
referred pain
originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs
somatic pain
- second stage of labor
- pain described as intense, sharp, burning, and localized
- Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions and lacerations of soft tissue
first stage labor pain
- Visceral
- Uterine contractions – cervical dilation & effacement
- Referred pain
- T10-T12 (thoracic nerves)originate in urterine body and cervix
second stage labor pain
-Somatic
-Intense, sharp, burning, & well localized
-Pain secondary to stretching and distention of perineal tissue
S2-S4 (pain impulses through spinal nerve segments)
third stage labor pain
- placenta
- similiar to first
- “afterpains”
np pain management
- Position change
- Patterned breathing/relaxation
- Hydrotherapy
- Aromatherapy
- Hypnobirthing
p pain management
Opiate Narcotics/Benzodiazepines/Phenothiazines
Local
Epidural
np and p pain management
Used together, they increase the level of pain relief and create a more positive labor experience
regional anesthesia
epidural is primary option for labor
systemic analgesia
- Opioid (narcotic) agonist analgesics
- Morphine
- Fentanyl
- Demerol
opioid agonist antagonist
Nubain/Nalbuphine
Stadol/Butorphanol
narcan
opioid antagonist
opioid withdrawal
Use of opioid agonist-antagonist analgesics in women with preexisting opioid dependence may cause symptoms of abstinence syndrome
sedative hypnotics
- Potentiate the effect of the opiate and offer relaxation – Also have antiemetic properties
- Phenothiazines
- benzos (not used cause they cause harm to fetus)
phenothiazines
Phenergan
Compazine
epidural
-Prehydration!
-Blood pressure drop
-Blood flow diverted from non-essential organs
-Initial sx: maternal tachycardia, nausea, diaphoretic, dizziness
-Late sx: measurable maternal hypotension
Fetal effects: Late decelerations/fetal bradycardia
-
priority for fetal hr after epidural
turn mom on side to allow placental perfusion
maternal bp
The most important nursing intervention after the injection of epidural anesthesia is monitoring:
chinese
- dont react to pain
- think its impolite to accept something when its first offered so you have to repeatedly ask about pain meds
- may use accupuncture for pain relief
arab or middle east
- vocal in response to labor pain
- they prefer pain meds
japanese
- are stotic in response to pain
- may as for pain meds when pain is severe
southeast asian
may endure sevre pain before asking for relief
hispanic
-are stotic until late in labor when they become vocal and request pain meds
native american
- may use meds or remedies made from plants
- stotic in response to pain
african
- express pain openly
- use of pain meds varies
