Chapter 17 Flashcards
Pain is what?
A highly individualized phenomena with sensory and emotional components
There two types of pain what are the names?
Somatic
Visceral
What is somatic pain?
Comes from the skin, muscles and soft tissue
What’s visceral pain?
Comes from the internal organs
What does visceral pain mean in labor and deliver terms?
What about in visceral labor pain occur?
It’s vague, not localized
It often feels like a deep sqeeuze, pressure or aching
( contraction pain!!)
During the early first stage and second stage of childbirth, this pressure allows the cervix to dilate
What does somatic pain mean in labor and delivery and when does it occur?
Shape pain in the vagina, rectum and premium
Closer to delivery
Can we control visceral pain?
And how?
Yes
Giving medications like epideral
Why is somatic pain harder to aid the pain?
The pressure feeling, we kinda want you to have it so you can push
What are some factors that influence pain?
Physiologic factors ( tolerance )
Culture
Anxiety
Previous experience
Gate control theory of pain
Comfort
Support
Environment
What is the gate control theory ?
How does it affect labor?
Pain goes up to your spinal cord and delivers it to the brain
We block the gate by epidural so we don’t feel the pain or like distraction
What type of breathing technique do we recommend patients?
Lamas breathing!!
What are some nonoharmacologic pain management?
Acupressure
Water therapy
Aromatherapy
Music
Hypnosis
Relaxing and breathing techniques
Touch and massage
Why do you want to practice breathing techniques before going into the labor?
Cause it’s hard to just teach you in the moment
What is effleurage and counter pressure??
Circle massage & counter pressure onto the back to help
Notes
It is unacceptable for woman in labor to endure severe pain when safe and effective relied measures are available !!
What does sedatives pharmacological medications mean?
Usually given when?
Relieve anxiety and induce sleep
Prolonged early phase of labor when we need mom to sleep in order to get strength back
What are some examples of sedatives?
Barbiturates
Phenothiazines
Benzodiazepines
What is anesthesia?
Encompasses analgesia, amnesia relaxation and reflex actvity
( overall term )
What is analgesia?
The alleviation of the sensation of pain or easing of the threshold for pain perception without loss of consciousness
( epidural )
( we didn’t knock you out )
The type of analgesic or anesthetic chosen is determined by what? (2)
Stage of labor of the women and by the method of birth plan
What is systemic analgesia?
Opioids readily cross the placenta ; effects on the fetus and newborn can be profound there analgesic effect in labor is limited
Opioids!!!
It’s super important to know that if we are going to get systemic analgesia, like opioids, what do we need to know about the baby?
How does this affect labor?
It’s also gonna get it cause it crosses the placenta
So if it’s gonna make mom relax, it’s also gonna make baby relax and not wanna be pushed out
So since opioids can cross the placenta, when can you give and not give?
Early stage ( contraction pain )
Not later stage ( like actual pushing labor )
We want to be careful with opioids so we want to have what on hand?
Narcan at bed side!!
What is nerve block analgesia and anesthesia?
Example of this is?
Used to produce sensory blockage and various degrees of motor block age over a specific region of the body
Epidural
We have to be very careful with epidural, it can give her a spinal headache so what do we give?
But when do you give this ___or when can you give it to her?
Blood patch
After baby is born
What’s the most common thing we use for labor?
What does it really do?
Why don’t we medicate the mom when they are feeling the pressure??
Epidural anesthesia or analgesia
Taking the visceral pain away
( when she gets ready to push, she’ll feel the pressure )
Because we want them to push!!
What is a combined spinal epidural?
Walking epidural !!!
Like you can move compared to like a normal epidural which numbs your leg
What is epidural or spinal opioids?
Just like the immediate relief into your spine of like FET.
We want to be careful with opioids and epidurals because mom can go into?
A hypotensive state and that effects baby circulation and health
So before giving an epidural and opioids, we give them a what?
If it still drops with this what do we do?
Bolus 500 cc of fluid up to 1000cc
Give them another Bolus
Notes
Contraindications
Maternal hypotension
Maternal coagulopathy
Infection at the site
Increased intracranial pressure
Allergies to the anesthetic drug
Some types of maternal cardiac condition
What do anesthesia do before giving epidural ?
And why do they do this?
They check there platelets counts
To see if they can clot because they will bleed a lot from the site
Notes
Epidural block effects on newborn
- no evidence that is has a significant effect on the child’s later mental and neurologic development
What is nitrous oxide for analgesia?
Breathing this in to help pain !!
(50% or less )
Notes
General anesthesia
- rarely used
- the woman should be premeditated with clear oral antacid to neutralize the acidic contents of the stomach
Because the risk for neonatal necrosis
Notes
Just asking pain scale
Assess and evaluate
