Chapter 17: Maximizing Comfort for the Laboring Woman Flashcards
_______ describes the discomfort felt during the first stage of labor
Visceral pain
_______ pain and is related to the changes in the cervix, uterine ischemia, and distention of the lower uterine segment
Visceral pain
_______ is often described as a dull aching pain
visceral pain
_______ describes pain that originates in the uterus and radiates to the abdominal wall, the lumbosacral area of the back, iliac crest, gluteus maximus, and down the thighs
referred pain
________ is fast, localized, intense, sharp, burning, prickling pain
somatic pain
________ pain occurs usually during the second stage of labor
somatic
_________ pain is associated with the stretching and distention of the perineal body
somatic
during labor, the sympathetic nervous system responds to pain with increased levels of_________
catecholamines (epinephrine and norepinephrine)
increased maternal oxygen consumption results in________
respiratory alkalosis
if there is a history of dysmenorrhea, increased childbirth pain might be r/t __________
higher levels of circulating prostaglandins
_______ are endogenous opioids secreted by the pituitary gland and produce analgesia
endorphins
maternal anxiety during labor triggers the release of ________
catecholamines
________ increase the amount of pelvic pain stimuli sent to the brain which causes an intensified perception of pain
catecholamines
during early labor when the woman can no longer walk or talk through contractions she might want to start _________ breathing
slow paced
breathing techniques always start and end with _______
slow, deep, cleansing breath
_______ is a breathing pattern in which the woman begins to breathe slowly in and out of her mouth while the support person counts out loud
slow paced breathing
during slow paced breathing, the woman should take ________ breaths per minute
6-8
the breathing count for slow paced breathing is:
inhale 1, 2, 3, 4
exhale 1, 2, 3, 4
as labor progresses and the contractions increase in intensity and frequency, the patient may need to switch to ________ breathing
modified-paced breathing
during this breathing techniques, breaths are shallow and at a rate of 32-40 breaths per minute
modified- paced breathing
during this breathing technique the woman inhales slowly and exhales fast
modified-paced breathing
when should patients use the pattern paced breathing
during the transition phase when contractions are most intense
what is pattern paced breathing
inhale/ exhale three or four times and then exhale with pursed lips on the last breath
_______ is a gentle stroking technique performed in rhythm with contractions
effleurage
with the ________ technique, the support person massaged mommy’s belly in circular motions
effleurage
________ is a pain relief technique in which the support person uses their fist or heel of the hand to apply steady pressure to the sacral area
counterpressure
________ pain relief technique is especially useful when maternal back pain results from the fetus occiput is pressing against the sacral nerves
counterpressure
_______ is based on the use of the body’s prana (energy fields)
therapeutic touch
_______ is based on the body’s energy fields and employs a combination of techniques from multiple disciplines
healing touch
_______ is the use of warm water to promote comfort and relaxation
hydrotherapy
immersion in a hot tub during labor decreases the production of maternal ________ which prompts an increase in _______ and _______
catecholamines; oxytocin; endorphins
when the fetus is in transverse or occiput posterior position, these two positions provide comfort and help facilitate fetal rotation
side lying and hands and knees position
_______ is a structured technique that enables the patient to achieve a state of heightened awareness and focused concentration that can be used to alter their perception of pain
hypnosis
________ is the use of essential oils derived from plants, flowers, herbs, and trees whose aroma is thought to have healing effects
aromatherapy
four fragrances thought to promote comfort and relaxation and reduce pain: 1. 2. 3. 4.
- rose
- lavender
- frankincense
- bergamot
the application of _______ and ________ should be used alternately to enhance their effects
hot; cold
_______ exerts therapeutic effect by relieving muscle ischemia and increasing blood flow to the area of discomfort
heat
application of ________ to the perineum helps with pain associated with scratching and can prevent tearing during the second stage of labor
heat
_________ exert therapeutic effect by reducing muscle temperature and relieving muscle spasms
cold packs
________ involves the delivery of an electric current through electrodes that are applied to the skin over the painful region of a peripheral nerve
transcutaneous electrical nerve stimulation (TENS)
________ is a technique in which a small needle injects small amounts of water into four locations on the patient’s lower back to relieve back pain
intradermal water block
how much sterile water is used in an intradermal water block
.005- .01 mL
where are the four locations for intradermal water block
two over the posterior iliac spine and two 3 cm below and 1 cm medially to the first two
in order for mommy to receive _______ uterine contractions should be consistent
analgesics
______ are commonly used in labor, but they can cross the placenta and cause neonatal respiratory distress
opioids
_______ are agents used to relieve anxiety and induce sleep
sedatives
sedatives are typically used for women who:
are in a prolonged latent phase and pain and anxiety need to be reduced
common opioids used during labor include:
- fentanyl
- nubain (nalbuphine)
- morphine
- Stadol (butorphanol)
__________ is the the alleviation of the sensation of pain or the raising of the threshold for pain perception without loss of consciousness
analgesia
benzodiazepine antagonist:
Flumazenil
hydromorphone hydrochloride, meperidine hydrochloride, fentanyl citrate, and sufentanil are all examples of:
Opioid Agonist Analgesics
opioid analgesia should be given:
either less than one hour or grater than four hours before birth to minimize neonatal depression
butorphanol and nalbuphine are examples of:
opioid agonist-antagonist analgesics
_________ is used to provide pain control when an episiotomy is performed or if sutures are necessary in the perineum
local perineal infiltration anesthesia
_______ is a nerve block that provides pain relief in the lower vagina, vulva, and perineum
pudendal nerve block
when should a pudendal nerve block be administered
10-20 minutes before perineal anesthesia is needed- usually late in the second stage of labor when an episiotomy is necessary
__________ is an injection of a solution containing a local anesthetic combined with fentanyl through the third, fourth, or fifth lumbar space to the subarachnoid space
spinal anesthesia block
most common complication of a spinal anesthesia block
hypotension
_________ is a complication hat can occur within 48 hours after a spinal puncture and is believed to occur from a leakage of CSF
post-dural puncture headache
a post-dural puncture headache characteristically gets worse when:
the patient sits up
treatment of a post-dural puncture headache includes:
oral analgesics, bedrest in a dark room, caffeine, and hydration
epidural blood patch
10-20 mL of the patient’s blood is slowly injected into the lumbar epidural space and forms a clot so no more CSF leaks
the most effective pharmacologic pain relief in labor is:
epidural anesthesia or analgesia block
________ is the injection of a local anesthetic or an opioid (or both) into the epidural space
epidural anesthesia or analgesia block
________ is the most commonly used method of pain control during labor
lumbar epidural and block
how to prevent hypotension from an epidural
preloading the patient with a rapid infusion of IV fluids
an accidental injection of a local anesthetic into a blood vessel can cause
CNS effects: weird behavior, disorientation, excitation
for relief of pain during a vaginal delivery, a block from ______ to ______ is performed
T5; T10
when is a block given for a vaginal birth
when cervix is dilate 5-6 cm
for a caesarian birth a block from _____ to _____ is required
T8-S1
a ________ is sometimes used to block pain transmission without interfering with motor ability
combined spinal-epidural analgesia
aka walking epidural
nitrous oxide can be mixed with oxygen and can be inhaled at _____ or less to provide analgesia during ______ and ______ stages of labor
50%; 1st; second
where does local perineal infiltration work
perineum
where does the pudendal nerve block work
perineum and lower vagina
where is a spinal anesthesia block felt
uterus, cervix, vagina, and perineum
where is a lumbar epidural block felt
uterus, cervix, vagina, and perineum
where is a combined spinal-epidural felt
uterus, cervix, vagina, and perineum
when can local perineal infiltration be administered
immediately before or after birth
when can a pudendal nerve block be given
late in second stage for episiotomy, forceps or vacuum, and during third stage for repairs
when can spinal anesthesia block be given
first stage for elective and emergent c-sections
when is a combined spinal-epidural given?
spinal analgesics can be given during latent phase and then the epidural is given when active labor begins
