ch. 17 comfort during labor Flashcards
types of pain during labor and birth (neurological (2) origins, perception of pain (8), expression (2))
1) neurological origins:
- visceral: distention of lower uterine segment, cervix (opening up), pressure
- somatic (affects muskuloskeletal, soft tissues, bones, muscle, skin, mucous membranes): intense, sharp, burning, local
2) perception of pain:
- culture, age, previous experiences, parity (# of babies), emotional support, previous trauma (childhood trauma), length of labor, # medical procedures
3) expression of pain:
- physiologic reactions -> affect of labor contractions, ability to cope, maternal positioning (nursing intervention to decrease pain)
- sensory or emotional reactions: Beta endorphins
TIP:
- beta endorphins DECREASE pain, give pleasure, eating chocolate
factors that influence pain (8)
- physiologic factors
- culture: nurse must understand how culture mediates the response to pain (family background, expectations)
- anxiety: increased pain, more catecholamine (epi, norepi release), ability to cope (distraction therapy, deep breathing, COUNTER PRESSURE ON LOWER BACK)
- previous experience
- gate control therapy: neural system capacity (explains how everyone has limits, want to decrease perception of pain via distraction)
- comfort: music, aromatherapy, water, hot/cold, breathing
- support: FOB, family, nurse
- environment: SHUT DOWN ROOM (dim lights, low noise level, music)
gate control therapy of pain (3)
spinal cord sends signal to brain to be processed and accentuate perception of pain
- nervous system has a capacity for pain and decides what is percieved as pain and what isn’t
- important to use distraction therapy!
methods for preparing for labor and birth (11)
1) relaxing and breathing techniques
- focusing and relaxation techniques: focal point to focus on when breahting
- breathing techniques (upon contraction):
(a) slow breathing (4/4 breathing in and out)
(b) quick breathing (“hee-ho”, rapid breathing, tongue on top palate)
(c) patterned breathing (rhythmic breathing - be careful -> can become alkaloic and decrease CO2)
2) effleurage and counter pressure
- light massage around belly and with both hands
- push pelvic bone in (at side of abdomen), pain in lower back (counter pressure)
3) touch and massage
4) application of heat and cold: can be either, ,medical injury (ice first)
5) acupressure and acupuncture
6) transcutaneous electrical nerve stimulation (TENS)
7) water therapy (hydrotherapy)
8) intradermal water block:
- used to decrease pain perception
- inject small amounts of water -> lower back cause labor reject) (1/2 cc, 4 points)
9) aromatherapy
10) music
11) hypnosis
effective comfort measures (non pharm) (8)
- providing information
- encouragement
- back rubs, shoulder rubs
- clean linen
- positional changes (ambulation)
- relaxation, breathing techniques
- heat/cold
- aromatherapy, music
effective comfort measures induction pharm (3)
- decrease discomfort
- increase relaxation
- reestablish ability to participate more actively in the labor and birth experience
pharmacologic pain mgmt types (3)
1) systemic analgesia
2) nerve block analgesia, anesthesia
3) sedatives
systemic analgesia (what, types (3))
opioids readily cross the placenta
- has effects on the fetus/newborn can be profound
- analgesic effect in labor is LIMITED
- quick acting, usually effective
types:
1) opioid (narcotic) agonist analgesics
2) opioid (narcotic) agnostic-antagonistist analgesics
3) opioid (narcotic) antagonists (narcan)
TIP:
- most substance users use before coming in to decrease anxiety
nerve block analgesia and anesthetics (what, types (3) )
used to produce sensory blockade and various degrees of motor blockade over a specific region of the body
- local perineal infiltration anesthesia (sensory)
- pudendal nerve block (sensory)
- spinal anesthesia (block) (sensory/motor)
(a) post dural puncture headaches (complicaion of puncture to dura mater)
(b) epidural blood patch (procedure done to stop leakage of CSF and spinal headaches)
sedatives (what, 3 types)
relieve anxiety and induce sleep
- may be given to a woman experiencing a prolonged early phase of labor when there is a need to decrease anxiety and promote sleep (amniotic sac released, no contractions though)
(a) barbiturates:
- seldom used in obstetrics (seconal, ambien)
(b) phenothiazines:
- seldom used in obstetrics (compazine, prolixin)
- used for psychosis
(c) benzodiazepines:
- when given with an opioid analgesic, pain relief is enhanced, and nausea/vomiting are reduced (valium, versed) (sometimes given together)
opioid analgesics: fentanyl (sublimaze) (what, onset, dosage, usage, nursing, must confirm, critical, if neccessary)
short acting opioid with moderate analgesia & mild sedation qualities
- rapid onset; short half life
- dosage: 50-100 mcg Hour
- usage: woman in active labor
- nursing: drug dependency?
- must confirm that patient has no opioid dependency or addiction
- CRITICAL: OBSERVE FOR RESPIRATORY DEPRESSION in mother and baby
- use narcan if necessary
nubain (nalbuphine hydrochloride) (class, dose/route/frequency, side effects (5), life threatening reactions (2), contraindications)
1) class: CNS agent, analgesic, narcotic agonist, antagonist
2) dose, route, frequent: 10-20 mg every 3-6 hours PRN SQ/IM/IV
3) common side effects: sedation, sweaty, clammy skin, nausea/vomiting
4) life threatening reactions: respiratory depression, all opioids life threaten reaction
5) contraindication: hypersensitivity to drug
TIP: opiate analgesic not as strong as fentanyl
- narcotic analgesic
epidural anesthesia or analgesia (block) (what, disadvantages)
1) most effective pharmacologic pain relief method for labor
- effectively relives the pain caused by uterine contractions but does NOT completely remove the pressure sensations (TIP: sensory, NOT MOTOR)
2) disadvantages:
- MATERNAL HYPOTENSION
- generalized itching: give Benadryl
- variations in level of relief: sometimes doesn’t work!
TIP:
maternal hypotension tx:
- increase IV fluids
- meds to increase BP
HOWEVER: if early renal failure, can bolus to prevent maternal hypotension, question fluid intake and length of labor
combined spinal epidural (CSE) (what, 2)
analgesia, aka “walking epidural”
- most women don’t walk however due to sedation and fatigue, abnormal sensations in and weakness of LE, feeling of insecurity
- go into dura space/spinal column to place epidural
TIP:
caution women on blood thinners as it can cause patient to bleed into spinal cavity
epidural and intrathecal (spinal) opioids (4)
- continuous infusion of fentanyl and morphine
- may affect fetus
- usually used for post op pain
- usually given in combination with local anesthetic due to not providing adequate analgesia
