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OB > Chapter 17: Maximizing Comfort for the Laboring Woman > Flashcards

Chapter 17: Maximizing Comfort for the Laboring Woman Flashcards

1
Q

_______ describes the discomfort felt during the first stage of labor

A

Visceral pain

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2
Q

_______ pain and is related to the changes in the cervix, uterine ischemia, and distention of the lower uterine segment

A

Visceral pain

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3
Q

_______ is often described as a dull aching pain

A

visceral pain

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4
Q

_______ 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

A

referred pain

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5
Q

________ is fast, localized, intense, sharp, burning, prickling pain

A

somatic pain

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6
Q

________ pain occurs usually during the second stage of labor

A

somatic

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7
Q

_________ pain is associated with the stretching and distention of the perineal body

A

somatic

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8
Q

during labor, the sympathetic nervous system responds to pain with increased levels of_________

A

catecholamines (epinephrine and norepinephrine)

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9
Q

increased maternal oxygen consumption results in________

A

respiratory alkalosis

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10
Q

if there is a history of dysmenorrhea, increased childbirth pain might be r/t __________

A

higher levels of circulating prostaglandins

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11
Q

_______ are endogenous opioids secreted by the pituitary gland and produce analgesia

A

endorphins

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12
Q

maternal anxiety during labor triggers the release of ________

A

catecholamines

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13
Q

________ increase the amount of pelvic pain stimuli sent to the brain which causes an intensified perception of pain

A

catecholamines

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14
Q

during early labor when the woman can no longer walk or talk through contractions she might want to start _________ breathing

A

slow paced

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15
Q

breathing techniques always start and end with _______

A

slow, deep, cleansing breath

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16
Q

_______ 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

A

slow paced breathing

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17
Q

during slow paced breathing, the woman should take ________ breaths per minute

A

6-8

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18
Q

the breathing count for slow paced breathing is:

A

inhale 1, 2, 3, 4

exhale 1, 2, 3, 4

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19
Q

as labor progresses and the contractions increase in intensity and frequency, the patient may need to switch to ________ breathing

A

modified-paced breathing

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20
Q

during this breathing techniques, breaths are shallow and at a rate of 32-40 breaths per minute

A

modified- paced breathing

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21
Q

during this breathing technique the woman inhales slowly and exhales fast

A

modified-paced breathing

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22
Q

when should patients use the pattern paced breathing

A

during the transition phase when contractions are most intense

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23
Q

what is pattern paced breathing

A

inhale/ exhale three or four times and then exhale with pursed lips on the last breath

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24
Q

_______ is a gentle stroking technique performed in rhythm with contractions

A

effleurage

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25
Q

with the ________ technique, the support person massaged mommy’s belly in circular motions

A

effleurage

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26
Q

________ 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

A

counterpressure

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27
Q

________ pain relief technique is especially useful when maternal back pain results from the fetus occiput is pressing against the sacral nerves

A

counterpressure

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28
Q

_______ is based on the use of the body’s prana (energy fields)

A

therapeutic touch

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29
Q

_______ is based on the body’s energy fields and employs a combination of techniques from multiple disciplines

A

healing touch

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30
Q

_______ is the use of warm water to promote comfort and relaxation

A

hydrotherapy

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31
Q

immersion in a hot tub during labor decreases the production of maternal ________ which prompts an increase in _______ and _______

A

catecholamines; oxytocin; endorphins

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32
Q

when the fetus is in transverse or occiput posterior position, these two positions provide comfort and help facilitate fetal rotation

A

side lying and hands and knees position

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33
Q

_______ 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

A

hypnosis

34
Q

________ is the use of essential oils derived from plants, flowers, herbs, and trees whose aroma is thought to have healing effects

A

aromatherapy

35
Q 
four fragrances thought to promote comfort and relaxation and reduce pain:
1.
2.
3.
4.
A
  1. rose
  2. lavender
  3. frankincense
  4. bergamot
36
Q

the application of _______ and ________ should be used alternately to enhance their effects

A

hot; cold

37
Q

_______ exerts therapeutic effect by relieving muscle ischemia and increasing blood flow to the area of discomfort

A

heat

38
Q

application of ________ to the perineum helps with pain associated with scratching and can prevent tearing during the second stage of labor

A

heat

39
Q

_________ exert therapeutic effect by reducing muscle temperature and relieving muscle spasms

A

cold packs

40
Q

________ involves the delivery of an electric current through electrodes that are applied to the skin over the painful region of a peripheral nerve

A

transcutaneous electrical nerve stimulation (TENS)

41
Q

________ 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

A

intradermal water block

42
Q

how much sterile water is used in an intradermal water block

A

.005- .01 mL

43
Q

where are the four locations for intradermal water block

A

two over the posterior iliac spine and two 3 cm below and 1 cm medially to the first two

44
Q

in order for mommy to receive _______ uterine contractions should be consistent

A

analgesics

45
Q

______ are commonly used in labor, but they can cross the placenta and cause neonatal respiratory distress

A

opioids

46
Q

_______ are agents used to relieve anxiety and induce sleep

A

sedatives

47
Q

sedatives are typically used for women who:

A

are in a prolonged latent phase and pain and anxiety need to be reduced

48
Q

common opioids used during labor include:

A
  1. fentanyl
  2. nubain (nalbuphine)
  3. morphine
  4. Stadol (butorphanol)
49
Q

__________ is the the alleviation of the sensation of pain or the raising of the threshold for pain perception without loss of consciousness

A

analgesia

50
Q

benzodiazepine antagonist:

A

Flumazenil

51
Q

hydromorphone hydrochloride, meperidine hydrochloride, fentanyl citrate, and sufentanil are all examples of:

A

Opioid Agonist Analgesics

52
Q

opioid analgesia should be given:

A

either less than one hour or grater than four hours before birth to minimize neonatal depression

53
Q

butorphanol and nalbuphine are examples of:

A

opioid agonist-antagonist analgesics

54
Q

_________ is used to provide pain control when an episiotomy is performed or if sutures are necessary in the perineum

A

local perineal infiltration anesthesia

55
Q

_______ is a nerve block that provides pain relief in the lower vagina, vulva, and perineum

A

pudendal nerve block

56
Q

when should a pudendal nerve block be administered

A

10-20 minutes before perineal anesthesia is needed- usually late in the second stage of labor when an episiotomy is necessary

57
Q

__________ 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

A

spinal anesthesia block

58
Q

most common complication of a spinal anesthesia block

A

hypotension

59
Q

_________ is a complication hat can occur within 48 hours after a spinal puncture and is believed to occur from a leakage of CSF

A

post-dural puncture headache

60
Q

a post-dural puncture headache characteristically gets worse when:

A

the patient sits up

61
Q

treatment of a post-dural puncture headache includes:

A

oral analgesics, bedrest in a dark room, caffeine, and hydration

62
Q

epidural blood patch

A

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

63
Q

the most effective pharmacologic pain relief in labor is:

A

epidural anesthesia or analgesia block

64
Q

________ is the injection of a local anesthetic or an opioid (or both) into the epidural space

A

epidural anesthesia or analgesia block

65
Q

________ is the most commonly used method of pain control during labor

A

lumbar epidural and block

66
Q

how to prevent hypotension from an epidural

A

preloading the patient with a rapid infusion of IV fluids

67
Q

an accidental injection of a local anesthetic into a blood vessel can cause

A

CNS effects: weird behavior, disorientation, excitation

68
Q

for relief of pain during a vaginal delivery, a block from ______ to ______ is performed

A

T5; T10

69
Q

when is a block given for a vaginal birth

A

when cervix is dilate 5-6 cm

70
Q

for a caesarian birth a block from _____ to _____ is required

A

T8-S1

71
Q

a ________ is sometimes used to block pain transmission without interfering with motor ability

A

combined spinal-epidural analgesia

aka walking epidural

72
Q

nitrous oxide can be mixed with oxygen and can be inhaled at _____ or less to provide analgesia during ______ and ______ stages of labor

A

50%; 1st; second

73
Q

where does local perineal infiltration work

A

perineum

74
Q

where does the pudendal nerve block work

A

perineum and lower vagina

75
Q

where is a spinal anesthesia block felt

A

uterus, cervix, vagina, and perineum

76
Q

where is a lumbar epidural block felt

A

uterus, cervix, vagina, and perineum

77
Q

where is a combined spinal-epidural felt

A

uterus, cervix, vagina, and perineum

78
Q

when can local perineal infiltration be administered

A

immediately before or after birth

79
Q

when can a pudendal nerve block be given

A

late in second stage for episiotomy, forceps or vacuum, and during third stage for repairs

80
Q

when can spinal anesthesia block be given

A

first stage for elective and emergent c-sections

81
Q

when is a combined spinal-epidural given?

A

spinal analgesics can be given during latent phase and then the epidural is given when active labor begins

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