Chapter 13 Flashcards
Exam 1
What are the 2 components of pain during birth?
Physiologic and Psychological
Pain is…
subjective and personal
Physiologic effects of pain
*fear and anxiety
*increases maternal metabolic rate and demand for oxygen
Psychological effects of pain
*maternal tolerance for pain
Pain during labor can either be…
visceral or somatic
mostly occurs during the 1st stage of labor due to uterine contractions that lead to hypoxia of the uterine muscles, dilations of the cervix, distension of the lower uterine segment, as well as pressure and pulling on pelvic structures such as the fallopian tubes, ovaries, and bladder
visceral pain
mostly occurs during the later part of the 1st stage and 2nd stage of labor, as the uterine contractions become more intense, During this time, pain is increased as the fetus pushes directly on maternal
somatic pain
sources of pain in childbirth
1.) tissue ischemia
2.) cervical dilation
3.) pressure and pulling on pelvic structures
4.) distention of the vagina and perineum
Factors affecting PERCEPTION or tolerance of pain
1.) labor intensity
2.) cervical readiness
3.) fetal position
4.) pelvic anatomy
5.) fatigue
6.) caregiver interventions
severe pain occurs quickly as each contraction is highly effective, limiting options for pain relief and reducing the client’s ability to cope due to shorter recovery time
in precipitous labor
minimal changes to the what before labor can make dilation slower and less efficient, prolonging labor and causing greater fatigue for the client
cervical/ cervical readiness
labor is likely to be longer and more uncomfortable when the fetus is in what?
an unfavorable fetal position in relationship to the birthing pelvis
What of the client’s pelvis influences the course and length of labor?
size and shape (pelvic anatomy)
What can improve a client’s pain coping ability?
past pain experiences unless previous births were challenging they may feel more anxious
How do some clients manage pain?
*positional changes
*breathing techniques
*hydrotherapy
What is foundation for preparation for childbirth?
education
What should be initiated before administering pharmacologic treatment for pain management in labor?
nonpharmacologic measures
examples of nonpharmalogical measures for pain management
*ambulation
*effleurage and counter-pressure
*touch and massage
*changing positions and rocking
*engaging in support persons
*breathing and relaxation techniques
*transcutaneous electrical nerve stimulation
*application of heat and cold
*aromatherapy
*hydrotherapy
What are some advantages of nonpharmalogic measures?
*does not slow labor
*no side effects or risk of allergy
*some pharm methods may not eliminate labor pain
*may be the only realistic option in advanced rapid labor
limitations of nonphar measures
*desired level of pain control is not always achieved
*even in well-prepared and highly motivated woman may have difficult labor and need analgesia or anestheisa
Transmission of nerve impulses controlled by a neural mechanism in the dorsal horn of the spinal cord that transmits impulses to the brain
gate control theory
is transmitted through small-diameter sensory nerve fibers
pain
stimulations of large- diameter skin fibers blocks pain signals from what?
small- diameter fibers, “closing the gate” and reducing pain perception
preparation for pain management
*childbirth classes
*ideal time to prepare- before labor
*support person learns specific methods to encourage and support
*nurse can teach or reinforce
*latent phase of labor is the best time for intrapartum teaching
What begins with prenatal education?
management of labor pain