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OB > ch 17 - labor pain > Flashcards

ch 17 - labor pain Flashcards

1
Q

2 big roles of the nurse during labor

A

-eliminate/minimize pain
-provide support for effective coping

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2
Q

sources of pain during labor

A

-stretching
-pressure
-muscle hypoxia
-distention
-emotional tension

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3
Q

factors affecting response to pain

A

-knowledge
-culture
-personal experience
-fatigue/sleep deprivation
-anxiety
-attention and distraction
-emotional support

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4
Q

results of the work of labor (5)

A

-fatigue
-diaphoresis
-muscle cramps
-positional discomforts
-N/V

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5
Q

maternal effects of pain in labor (4)

A

-increased maternal O2 consumption
-increased catecholamine secretion (epi/norepi)
-slows progress of labor
-decreases mom’s self confidence

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6
Q

S+S of pain in labor (6)

A

-request for meds/epidural
-ineffective use of pain control measures
-screaming, thrashing, crying
-hyperventilation
-sweating, shaking
-inability to relax (especially between contractions)

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7
Q

methods of pain management during labor

A

-comfort measures: support, environmental control, nursing care
-non-pharmacologic methods
-pharmacologic methods (systemic drugs, regional nerve blocks)
-combo of methods

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8
Q

2 theories in non-pharmacologic pain management

A

-fear tension pain syndrome
-gate control theory

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9
Q

theory: brain can only process so many pain signals from a part of the body

A

gate control theory

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10
Q

cognitive non-pharmacologic methods of pain control during labor (2)

A

-childbirth education
-hypnosis

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11
Q

sensory non-pharmacologic methods of pain control during labor (5)

A

-aromatherapy
-breathing techniques
-music
-imagery
-focal points

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12
Q

S+S hyperventilation (+resp alk)

A

-light headedness
-dizziness
-tingling of fingers
-numbness around mouth

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13
Q

breathing patterns (3)

A

-slowed: abdominal breathing (in 4 secs, out 4 secs)
-cleansing breath (deep breath in and out)
-modified: pant pant blow (“he he ho”)

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14
Q

other non-pharmacologic methods of pain control during labor

A

-counterpressure
-acupressure/acupuncture
-effleurage, therapeutic touch, massage
-heat and cold, TENS
-water therapy

POSITION:
-walking, rocking, position changes, labor dance

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15
Q

limitations/disadvantages of hydrotherapy

A

-infection (maybe can’t use with ROM)
-no electric fetal monitoring
-overheating
-underwater birth (unplanned)
-cleaning/universal precautions
-birth attendant discomfort

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16
Q

positions for labor

A

-sitting/squatting
-lateral/side lying
-hands and knees

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17
Q

pharmacologic categories of pain control during labor (3)

A

-systemic sedatives and analgesics
-nerve block analgesia and anesthesia
-general anesthesia

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18
Q

assessments for pharmacologic interventions during labor

A

-drug allergies, Hx of liver and kidney damage
-patient desires, birth plan
-stage of labor, cervical exam, contraction pattern
-lab values (Hgb, Hct, plts, clotting time)
-hydration status
-S+S infections
-degree of pain
-response to nonpharmacologic measures
-stable maternal VS
-good contraction pattern
-guideline: atleast 4-5 cm (1st time mom), 3-4 cm (2+ time mom)
-stable fetal VS

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19
Q

pharmacologic pain management: relieve anxiety and induce sleep; typically used for women in in a prolonged latent phase of labor when there is a need to lessen the intensity of the contractions, decrease anxiety, or promote sleep; generally contraindicated in active labor

A

sedatives

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20
Q

barbiturate sedatives (2)

A

secobarbital
zolpidem (ambien)

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21
Q

benzodiazepine sedatives (after delivery) (1)

A

diazepam (valium)

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22
Q

phenothiazine sedative (opioid agonist) (1)

A

promethazine (phenergan)

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23
Q

metoclopramide action

A

antiemetic
potentiates analgesics

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24
Q

2 classes opioids

A

OPIOID AGONIST
-takes edge off pain
-can cause significant resp depression in newborn
***not appropriate for right before birth

OPIOID AGONIST-ANTAGONIST
-pain relief
-don’t typically cause resp depression

25
Q

opioid agonist meds (3)

A

-meperidine (demerol)
-fentanyl (sublimaze)
-remifentanil (ultiva)

26
Q

opioid agonist-antagonist meds (2)

A

-butorphanol (stadol)
-nalbuphine (nubain)

27
Q

opiate antagonist

A

naloxone (narcan)
*half life is less than half life of narcotics

28
Q

why are meds preferably given IV during labor

A

-stomach isn’t emptying
-quicker absorption
-N/V

29
Q

IV onset, peak, and duration times

A

onset: 5 or less mins
peak: 30 min
duration: 1-2 hr

30
Q

IM onset, peak, and duration times

A

onset: within 30 mins
peak: 1-3 hr
duration: 4-6 hr

31
Q

who should not receive opioid agonist-antagonist med (highly contraindicated)

A

patient with narcotic dependency
*puts mother and fetus into drug withdrawal

32
Q

side effects nitrous oxide (3)

A

-N/V
-drowsiness, dizziness, hazy memory
-LOC (especially if combined with narcotics)

33
Q

2 types regional nerve blocks

A

REGIONAL ANALGESIA
-some pain relief and motor block

REGIONAL ANESTHESIA
-complete pain relief and motor block

34
Q

agents used in local anesthetic agents

A

“-caine”
-bupivacaine
-chloroprocaine
-lidocaine

35
Q

when is local infiltration anesthetic used during labor

A

right before birth if dr knows tearing or episiotomy will happen

36
Q

when is pudendal block anesthetic used during labor

A

“extended local anesthetic”
-injected in pudendal nerve
-takes 10-20 mins to kick in
-often given when vacuum/forceps will be used

37
Q

when is spinal block anesthetic used

A

for C-section
effective immediately, shorter duration

38
Q

when is epidural block anesthetic used

A

for vaginal delivery
runs continuously, but can take a bit of time to kick in

39
Q

where is spinal block anesthetic needle placed

A

subarachnoid space in CSF

40
Q

where is epidural block anesthetic needle placed

A

epidural space between dura mater and fascia

41
Q

CLE

A

continuous lumbar epidural

42
Q

CLE

A

continuous lumbar epidural

43
Q

epidural level determinants (3)

A

-location of catheter tip
-dose and volume of anesthetic agent used
-woman’s position

44
Q

advantages to epidural (4)

A

-effective
-decrease catecholamines
-decrease hyperventilation
-awake and alert

45
Q

disadvantages to epidural (5)

A

-cost
-continuous EFM, IV
-loss of sensation and limited movement
-bladder atony with urinary retention
-increased risk: PPH, operative vaginal birth (forceps, vacuum)

46
Q

epidural complications

A

-toxicity (gets into bloodstream)
-total spinal/high spinal
***hypoTN
-post dural puncture headaches (PDPH)
-neuropathy
-backache

47
Q

most common epidural complication

A

hypotension

48
Q

S+S regional anesthesia toxicity (5)

A

-tingling of extremities
-metallic taste in mouth
-ringing in ears
-confusion/uneasy feeling
-convulsion

49
Q

Tx post dural puncture headache (5)

A

-hydration
-caffeine
-dark room
-lie flat on bed
-possible postdural blood patch

50
Q

rare epidural complications (6)

A

-hyperthermia
-length of labor (increased)
-second stage (mom can’t feel urge to push/if they’re pushing)
-increases fetal malpositions (OP)
-use of oxytocin (bc epidural slows contractions)
-increased risk operative birth (forceps, vacuum, C/S)

51
Q

epidural and intrathecal opioid meds (“walking epidural”)
(used for postop C/S pain)

A

-fentayl
-sufentanil
-morphine

52
Q

advantages of opioid epidural/intrathecal meds

A

-no effect on bp
-can feel contractions but not pain
-pushing more effective
-motor function intact

53
Q

side effects of opioid epidural/intrathecal meds (4)

A

-pruritis
-N/V
-urinary retention
-resp depression (up to 24 hours)

54
Q

contraindications to epidurals (8)

A

-actual/anticipated serious hemorrhage
-uncorrected hypoTN
-infection at insertion site
-coagulopathy
-increased ICP
-drug allergy
-refusal/inability to cooperate
-certain cardiac conditions

55
Q

S+S maternal hypoTN with decreased placental perfusion

A

-maternal hypoTN
-fetal bradycardia
-decreased FHR variability

56
Q

nursing interventions for maternal hypoTN after epidural (7)

A

-turn mom to side
-maintain IV infusion, increase rate/give bolus
-O2 8-10 L/min
-elevate legs
-notify hcp
-possibly administer IV vasopressor (ephedrine 5-10 mg)
-monitor maternal bp and FHR q5mins until stable

57
Q

when is general anesthesia used during labor

A

C/S and no time/contraindication to epidural

58
Q

meds to minimize risks of aspiration with general anesthesia during labor

A

MEDS:
-nonparticulate antacid
-possible H2 receptor blocker (famotidine/ranitidine)
-possible metoclopramide

59
Q

how to minimize fetal exposure to general anesthetic agent

A

all surgical prep done before mom is anesthetized

OB (21 decks)

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