Chapter 15: Pain Management During Childbirth Flashcards
Agonist
Causing a physiologic effect
Analgesia
Relief of pain without loss of consciousness
Anesthesia
Loss of sensation, with or without loss of consciousness
Antagonist
Blocking effect of the drug
Cleansing breath
Deep breath taken at the beginning and end of each contraction
Endorphin
Natural substance similar to morphine
Habituation
Reduced effectiveness of a pain management method after prolonged use
Paced breathing
Learned breathing techniques used during labor
Sellick maneuver
Blocking the esophagus by pressing the trachea against it
Valsalva maneuver
Holding the breath while pushing against a closed glottis
What is the difference between pain threshhold and pain tolerance? What factors can influence a woman’s pain tolerance during labor, positively or negatively?
Pain threshhold is the minimum stimulus that a person perceives as painful; it is relatively constant under different conditions. Pain tolerance is the maximum amount of pain that a person is willing to endure; it may change with the circumstances. Factors influencing pain tolerance during labor include intensity of labor, readiness of the cervix to dilate with the force of contractions, fetal position, pelvic size and shape, maternal fatigue and hunger, or interventions of caregivers (a positive or negative influence).
How can excessive maternal pain reduce fetal oxygenation?
Excess maternal pain can result in fear and anxiety, which stimulate the mother’s sympathetic nervous system to release substances that simultaneously cause vasoconstriction and pooling of blood in the mother’s vascular system, plus a higher uterine muscle tone with reduction of effective contractions. The net effect is that blood flow to and from the placenta falls and labor contractions are less effective, thus prolonging labor.
How is labor affected when the fetus is in an occiput posterior (OP) position?
The fetal occiput is pushed against the woman’s sacral promontory with each contraction, causing intense back pain. In addition, the fetus must usually rotate into the occiput anterior position to be born, so labor is often longer.
What are key features of each type of breathing technique and variations of each type that the woman may choose:
a. Cleansing breath:
b. Slow-paced breathing:
c. Modified paced breathing:
d. Patterned paced breathing:
a. Cleansing breath: The cleansing breath releases tension, provides oxygen, clears the mind to focus on relaxing, signals the labor partner of contraction’s beginning or end; may be taken in any way comfortable.
b. Slow-paced breathing: Enhances relaxation and allows the woman to concentrate on relaxation and allows the woman to concentrate on relaxation rather than number of breaths; she may se nose, mouth, or combination breathing.
c. Modified paced breathing: Uses shallow but rapid breathing, and may be combined with slow-paced breathing.
d. Patterned paced breathing: Focus on pattern of breathing interferes with pain impulse transmission; some may make a special sound (‘hee’ ‘hoo’); the woman may vary number of breaths before blowing.
Which breathing technique can help a woman avoid pushing too early?
Blowing prevents glottis closure and breath-holding.
Describe hyperventilation and nursing interventions to help a woman correct the problem.
Rapid deep breathing results in loss of carbon dioxide, eventually resulting in respiratory alkalosis. The woman feels dizzy or lightheaded, with numbness and tingling of fingers and lips; tetany, stiffness of the face and lips, or carpopedal spasm may occur. Breathing into a paper bag or cupped hands causes rebreathing of carbon dioxide and correction of alkalosis.
Compare and contrast open glottis pushing with closed glottis pushing.
Traditional closed-glottis pushing may result in impaired blood flow to the uterus, is fatiguing for the woman, and has not proven to significantly shorten second stage. Open-glottis pushing improves maternal-fetal oxygenation and is more physiologic, but the second stage may be longer.
What is the purpose of giving a test dose before performing an epidural block? What would be signs of problems after the test dose, and what causes these signs?
The test dose is given to identify inadvertent dural or intravascular puncture before injection of the full dose of the anesthetic drug. Evidence of these problems includes rapid and intense motor and sensory block (subdural or subarachnoid injection) or numbness of the tongue and lips, lightheadedness, dizziness, and tinnitus (intravascular injection).
In which regional anesthesia method is it desirable to obtain cerebrospinal fluid (CSF)? Why?
The subarachnoid block (SAB) punctures the dura and arachnoid membranes, entering the space that contains cerebrospinal fluid. Appearance of a few drops of CSF confirms the correct location for injection of the anesthetic drug for this block.
If an infant receives nalaxone (Narcan), why should the nurse continue to monitor the infant for respiratory depression?
The duration of action for nalaxone is shorter than for most of the opioids it reverses. Respiratory depression could recur until effects of the opioid drug have abated.
What are methods to relieve the pain of a spinal headache?
Bed rest with oral or IV hydration; blood patch
