Chapter 12: Pain Management Flashcards
What is first consideration of the nurse when planning pain management measures?
Safety
What are the 6 factors the influence pain response?
- Physiologic factors
- Culture
- Comfort/Support
- Environment
- Anxiety
- Previous experience
What type of pain is felt during the first stage of labor?
internal visceral pain that can be felt as back and leg pain and referred pain
What causes the pain during the first stage of labor?
Dilation, effacement, and stretching of the cervix
Distention of the lower uterus
Contractions of uterus with resultant uterine ischemia
What is referred pain?
Occurs when the pain originates in the uterus and radiates to the:
- abdominal wall
- lumbosacral area of the back
- iliac crest
- gluteal area
- down thighs
What type of pain is felt during the second stage of labor?
Somatic pain with fetal descent and expulsion
What is somatic pain?
Often described as intense, sharp, burning, and well localized
What causes the pain during the second stage of labor?
Pressure and distention of vagina and perineum, described as “burning,” “splitting,” and “tearing”
Pressure and pulling on the pelvic structures (ligaments, fallopian tubes, ovaries, bladder, and peritoneum)
Lacerations of soft tissues of the cervix, vagina, and perineum
What type of pain is felt during the third stage of labor?
Pain with the expulsion of the placenta, similar to the pain experienced during the first stage
What causes the pain during the third stage of labor?
Uterine contractions
Pressure and pulling of pelvic structures
What causes the pain during the fourth stage of labor?
Distention and stretching of the vagina and perineum incurred during the second stage
Uterine contractions as the uterus starts the involution
Success of pain management is based on?
Gate-Control Theory of Pain
What is Gate-Control Theory of Pain?
Based on the concept that the sensory nerve pathways that pain sensations use to travel to the brain will allow only a limited number of sensations to travel at any given time
Distraction with use of multiple stimuli is based on what theory?
Gate-control theory
What are cognitive strategies to help manage pain?
Child birth education
Childbirth preparation methods such as Lamaze, Bradley, Grant Dick-Reed
Patterned breathing exercises
Focused relaxation
Doulas
Nursing implications include assessing signs for hyperventilation
Hypnosis
Biofeedback
What are sensory stimulation strategies to help manage pain?
Aromatherapy
Breathing techniques
Imagery
Music
Use of local points
Subdued lighting
What are cutaneous stimulation strategies to help manage pain?
Therapeutic touch and massage
Acupressure
Hydrotherapy
TENS therapy
Walking
Rocking
Effleurage
Sacral counter pressure
Application of heat or cold
Frequent maternal position changes
What are some sedatives (barbiturates)?
Secobarbital (Seconal)
Pentobarbital (Nembutal)
Phenobarbital (Lumnial)
When are sedatives typically used and for what?
During the early or latent phase of labor; before admission to L&D, to relieve anxiety and induce sleep
What are the maternal side effects of sedatives?
apprehension/disorientation, hyperactive, unsteady ambulation
What are the neonatal side effects of sedatives?
respiratory depression (do not give if giving birth within 12-24 hours)
What are some opioid analgesics?
meperidine hydrochloride (Demerol)
Fentanyl (Sublimaze)
Butorphanol (Stadol)
Nalbuphine (Nubain)
Which two opioids provide pain relief without causing significant respiratory depression in the mother or fetus?
Butorphanol and nalbuphine
How does opioid analgesics work?
Act on CNS to decrease the perception of pain without loss of consciousness
