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Women's Health Test I > Chapter 15: Pain Management > Flashcards

Chapter 15: Pain Management Flashcards

1
Q

unique nature of pain during childbirth

A
  • It is part of a normal process
  • Preparation time exists
  • It is self limiting – labor pain has a foreseeable end
  • Is not constant but intermittent
  • Labor ends with the birth of a baby à emotional significance for the child can make women tolerate more pain than she might expect
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2
Q

Physiological Effects of Pain

A
  • fear and anxiety–>stimulate sympathetic NS–>inc catecholamines–>stimulates alpha and beta receptors–>effects blood vessels and uterine muscles
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3
Q

what can occur with excessive childbirth pain?

A
  • Increases fear and anxiety
  • Increases catecholamines
  • Reduces uterine blood flow
  • Reduces ability of uterus to contract
  • Increases maternal blood pressure
  • Increases maternal need for oxygen
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4
Q

what are the 2 main effects excessive catecholamine secretions have?

A
  • excessive catecholamine secretions occur due to fear and anxiety
  • they cause:
    • Reduced blood flow to and from the placenta, restricting fetal oxygen supply and waste removal
    • Reduced effectiveness of uterine contractions, slowing labor progress
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5
Q

what are psychological effects of pain?

A
  • Mother may find it difficult to interact with infant b/c depleted from painful labor
  • Unpleasant memories of the birth may affect her response to sexual activity or another labor
  • Support person may feel inadequate during birth
  • Partner may feel helpless and frustrated when her pain is unrelieved
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6
Q

what are factors that affect a mother’s response to pain?

A
  • childbirth education
    • preparation for childbirth–allows woman to rehearse for labor
  • cultural background
  • fatigue/sleep deprivation–>interferes w/ attention and less energy
  • personal significance of pain
  • previous experience
  • anxiety
  • attention/distraction
    • ie. touch, massage, stroking, music, focal points, imagery
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7
Q

what type of pain dominates during the first stage of labor? what is it? why is that the type of pain?

A
  • Visceral pain is a slow, deep, poorly localized pain that is often described as dull or aching
    • Dominates during first stage labor as uterus contracts and cervix dilates
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8
Q

what type of pain dominates during the late first stage and second stage of labor? what is it? why is that the type of pain?

A
  • Somatic pain is quick, sharp and can be precisely localized
    • Most prominent during late first-stage labor and during second stage labor as the descending fetus puts direct pressure on maternal tissues
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9
Q

Physical Factors that influence perception/tolerance of pain Childbirth Pain

A
  • labor intensity
  • cervical readiness
  • fetal position
  • pelvic readiness
  • fatigue and hunger
  • caregiver interventions
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10
Q

Psychosocial Factors that influence perception or tolerance of Childbirth Pain

A
  • culture
  • anxiety and fear
  • previous experience
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11
Q

what are the 4 physical sources of pain?

A
  • tissue ischemia: blood supply to uterus dec during contractions
  • cervical dilation: dilation and stretching of cervix
  • pressure and pulling on pelvic structures: visceral pain and may be referred pain in back and legs
  • distention of vagina and perineum: occurs w/ fetal descent especially during the second stage
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12
Q

what are the standards for pain management?

A
  • The rights of all pt to pain management
  • Staff competency in pain assessment and management
  • Establishment of policies and procedures that support prescription of appropriate pain medications
  • Education of patients and families about effective pain management
  • Discharge planning related to pain management
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13
Q

what are some non-pharmacologic pain management techniques?

A
  • relaxation
  • cutaneous stimulation:
    • massage
    • counter pressure: sacral pressure may help with back pain that is intense when fetus is OP position
    • touch
    • thermal stimulation: warmth inc blood flow, relaxes muscles, and raises pain threshold
    • acupressure: can be used to help with n/v
  • hydrotherapy (need to be careful w/ infection risk)
  • mental stimulation: imagery or focal point
  • breathing techniques
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14
Q

how to prepare for pain management?

A
  • childbirth classes:
    • ideal time to prepare is 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
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15
Q

advantages of nonpharmacologic pain management

A
  • does not slow labor
  • no side effects or risk of allergy
  • some pharmacologic methods may not eliminate labor pain
  • may be only realistic option in advanced, rapid labor
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16
Q

limitations of nonpharmacologic pain management

A
  • desired level of pain control is not always achieved
  • even a well prepared and highly motivated woman may have a difficult labor and need analgesia or anesthesia
17
Q

special considerations for medicating a pregnant woman

A
  • Any drug taken by the woman is likely to affect the fetus
  • Drugs may have effects in pregnancy that they do not have in the non-pregnant person
  • Drugs can affect the course and length of labor
  • Pregnancy complications may limit the choice of pharmacologic pain management methods
18
Q

what effects can pharmacologic pain management have on the fetus?

A
  • they can have direct effects (if crosses placenta) or indirect effects (if mother then baby)
  • can cause bradycardia or late decelerations
19
Q

effects of pharmacologic pain management on the course of labor

A
  • Primarily the epidural block can slow progress during the second stage by reducing a woman’s spontaneous urge to push
  • Ideally analgesics are given when labor is well established to avoid slowing progress
20
Q

regional pain management

A
  • Used for intrapartum analgesia, surgical anesthesia or both – provides pain relief without LOC
  • anagesia and anesthesia are usually given in active phase
    • drugs given in latent phase may slow labor
    • drugs given in transition phase may affect newborn
  • no PO meds
    • IV best choice–slowly given at beginning of contraction
  • butorphanol or fentanyl
21
Q

advantages of regional pain management

A
  • Can still participate in birth yet have good pain control
    • awak and alert during birth
  • Can still feel pressure and discomfort but sensations are greatly reduced
22
Q

disadvantages of regional pain management

A
  • Depend on the technique
  • Effects on the fetus depend primarily on how the woman responds rather than on direct drug effects
23
Q

lumbar epidural

A
  • Regional block
  • Given during active phase for vaginal birth
  • Given right before a C/S
  • Given by anesthesiologist or CRNA
  • A local anesthetic and opiod into the tiny epidural space
  • Varied “levels”
  • Goal is analgesia, not anesthesia
  • Placed at L3-L4
  • Continuous with PCEA
24
Q

epidural block risks

A
  • improper placement
    • medication in subarachnoid space
  • dural puncture
    • causes spinal fluid leak and severe HA
  • maternal hypotension
  • bladder distention
  • prolonged 2nd stage (b/c less urge to push)
  • epidural catheter migration
  • maternal fever
25
Q

what to do for a severe HA caused by a dural puncture?

A
  • use a blood patch
    • so draw blood and inject that back into epidural space
  • worse upright, but less severe if lying flat
  • tx with bedrest, hydration, caffeine
  • more likely with SAB, but possible with epidural
26
Q

explain what to do for maternal hypoTN when using an epidural block

A
  • MUST preload with 500-1000 mL of LR before administration of epidural
  • if hypoTN crisis occurs, call for ephedrine
    • give IV bolus
    • reposition and give O2
  • monitor for late or prolonged decels
27
Q

what are ADRs of epidural opioids?

A
  • n/v
    • so give ondansetron
  • pruritis
    • so give diphenhydramine
  • delayed respiratory depression
    • have Naloxone ready
28
Q

nursing care with epidurals

A
  • baseline V/S and FHR patterns
  • IV preload
  • assist w/ positioning
    • sidelying
    • sitting
  • maternal BP and FHR
    • every 5 min for 15 min, then 30 min, then 1 hour
  • assist with urination
    • assess for need for catheter
29
Q

intrathecal opioid analgesics

A
  • walking epidural
  • opioid is injected into subarachnoid space
  • small doses, but big effect
  • fast, but short acting
  • fentanyl, sufentanil, morphine
  • watch for delayed respiratory depression
30
Q

subarachnoid (spinal) block (SAB)

A
  • performed by physician or CRNA
  • spinal fluid will be seen at needle hub to confirm placement
  • sensory and motor functions lost
  • watch for hypoTN and postdural puncture HA
31
Q

combined spinal and epidural (CSE)

A
  • primarily used for scheduled C/S
  • longer pain relief
  • often use Duramorph
32
Q

Duramorph

A
  • can be used in postpartum b/c lasts for 24 hours OR also used with CSE
  • causes a lot of pruritis so often give diphenhydramine
  • long acting morphine derivative
33
Q

systemic drugs used in labor

A
  • Nitrous Oxide–NO-often used in vaginal birth
  • pareteral analgesia:
    • usually Butorphanol
    • opioid agonist and antagonist
    • never give to opioid dependent women–>causes withdrawal in both woman and newborn
    • likely to cause respiratory depression in newborn, depending on when it is given
    • small frequent doses IV push
34
Q

opioid antagonists used in labor

A
  • Narcan (Naloxone)
    • used to reverse opioid induced respiratory depression in mother or baby
    • maternal dose: 0.4-2 mg IV
    • neonatal dose: 0.1 mg/kg
35
Q

adjunctive drugs used in labor

A
  • antiemetics: ondansetron
  • tranquilizers and sedatives (rare)
  • used to promote rest, reduce anxiety, and reduce nausea
36
Q

local infiltration anesthetic

A
  • given just before birth for epsiotomy by provider
  • ie. bupivicaine, lidocaine
  • numbs perineum
  • burning sensation before effective
  • can give w/ epinephrine to reduce bleeding
37
Q

pudendal block

A
  • given during the 2nd stage of labor
  • useful for episiotomy and/or low forceps
  • anesthetizes lower vagina/perineum
  • minimal effect on fetus unless it is placed intravascularly
38
Q

general anesthesia

A
  • mother will be unconsious
  • useful when rapid anesthesia is required, such as for an emergency C/S
  • ADRs:
    • maternal aspiration of gastric contents
      • usually give famotidine before C/S
    • respiratory depression of mom and/or baby
    • uterine relaxation and post partum hemorrhage
39
Q

nursing care for general anesthesia

A
  • place wedge under R hip
  • pre-oxgenate w/ 3-5 min of 100% O2
  • may depress fetus (reaches fetus in 2 min)

Women's Health Test I (8 decks)

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