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OB Exam Two > Chapter 7 Pain > Flashcards

Chapter 7 Pain Flashcards

1
Q

how can you promote decent of fetus and ease pain

A

position changes ( walking, standing, squatting, hand and knees, etc.) – in early labor we want them to ambulate

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2
Q

what is the preferred position for when laying in the bed

A

left side laying to promote fetal circulation and oxygenation

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3
Q

what is a pain threshold

A

least amount of pain necessary for a person to perceive it as pain

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4
Q

what is pain tolerance

A

ability of an individual to sustain pain once felt

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5
Q

what are the sources of pain

A

: dilation/stretching of cervix, reduced uterine blood supply during contractions, pressure of fetus on pelvis, stretching of vagina and perineum

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6
Q

what is the gate control theory

A
  • pain sensation travels along sensory nerve peathways to brain, but only a certain number of messages can go at once
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7
Q

how does relaxation work

A

relaxation requires concentrations – which occupies the mind and reduce muscle tension, decrease stress will decrease pain, relaxation will allow mom to do deeper breathing thus improving fetal circulation and breathing as well

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8
Q

what is effleurage

A

light touch distracts from discomfort – circular motions around the belly and thighs

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9
Q

what is counter pressure

A

heel of the hand or fist applied to moms sacral area, very good for babies who are sunny side up

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10
Q

what is hydrotherapy

A
  • use of warm water to promote comfort/relaxation like shower or soaking in the tub the warm water helps decrease muscle tension
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11
Q

how does hot/cold therapy work

A

heat relieves muscle ischemia and increases blood flow to area, can also use warm cloths to perineum and cold cloths to head, chest or face

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12
Q

how does TENs unit work

A

produces counterirritation on nociceptors to relieve pain

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13
Q

how does breathing therapy work

A

it should be practiced before labor, each breathing pattern and ends with cleansing breath can use deep breathing, paced breathing, or patterned paced breathing

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14
Q

what should you do before giving a medication and why

A

Check dilation first because you don’t want to give it too close to birth because too close birth because the baby will come out depressed

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15
Q

when and why are Sedatives/ antiemetics used

A

: used during early/ latent phase to relieve anxiety and help to aide in sleep

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16
Q

when and why are Barbiturates used

A

like secobarbitol sodium in early/latent labor to side in sleep

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17
Q

when and why are benzos used

A

like diazepam and lorazepam used in early labor to treat anxiety

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18
Q

when and why are H1-receptors used

A

like hydroxyzine, promethazine in early labor used as an antiemetic

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19
Q

what is an Analgesia

A

relief from pain – less pain or no pain

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20
Q

what is an anesthesia

A

partial or complete loss of sensation with or without loss of consciousness

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21
Q

what are the cons of anesthesia/Analgesia

A

affects mom and baby- respiratory depression, delayed suckling response, decrease alertness

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22
Q

how do you want to give oxytocin antagonist analgesia and why

A

You want to give it IV push so you can ensure to give it during a contraction so lees of the med gets to the baby (during a contraction less blood flow gets to the baby) timing is important

23
Q

if you give oxytocin antagonist analgesia too close to delivery what could happen

A

in the transition phase it could cause fetal respiratory depression and cardiac depression

24
Q

if you give oxytocin antagonist analgesia too early to delivery what could happen

A

like in the latent phase then it could slow labor progression

25
Q

if you give oxytocin antagonist analgesia at the right time what happens and when is the right time

A

1 hour or greater then 4 hours before birth – helps labor progress and decrease pain

26
Q

what are the pros of anesthesia/Analgesia

A

decreased respiratory depression and less n/v

27
Q

who do you not want to give oxytocin antagonist analgesia to

A

to moms with opioid dependance because it may precipice mother and baby withdrawl syndrome

28
Q

what is nitrous oxide and how does it work

A

inhaled gas, self administered by patient, 50/50 blend oxygen and nitrous oxide, Pain relief and decreased anxiety, gives state of euphoria

29
Q

what are the adverse effect to mom using nitrous oxide and how can you prevent it

A

: n/v, restlessness, anxiety – to prevent ask mom if she has had any reaction to laughing gas before

30
Q

what are the adverse fetal effects of nitrous oxide

A

none

31
Q

what is regional anesthesia and what must you have on stand by

A

Regional anesthesia: complete pain relief and motor block, Must have epinephrine, antihistamines, oxygen avalible for emergencies

32
Q

what is a reginal analgesia

A

provides some pain relief and motor block but not complete

33
Q

what is an epidural the combo of

A

analgesia and anesthesia

34
Q

where is the edidural space and how long does it take for the epidural to work

A

located outside dura matter, takes about 20-30 minutes to work

35
Q

before giving an epidural what should you give

A

IV bolus fluid

36
Q

what position is mom in to give an epidural

A

in side laying or sitting upright

37
Q

how does a test dose work for an epidural

A

via catheter – if they give numbness after the test dose it is likely that the dura matter has been punctured but if they get numbness around the mouth, tinnitus, visual disturbances, or gitteriness this could mean it is in the vein rather then dura matter

38
Q

what are the pros of an epidural

A

maternal relaxation, enhanced comfort and pain relief, little blood loss, minimal fetal effects

39
Q

what are the cons of an epidural

A

hypotension so BP is monitored continuously for 20 minutes (looking for systolic BP less then 100 or a drop of a 20 in hypertensive patient), lengthened duration of labor, always causes limited mobility also mom cant feel to push so she will need help

40
Q

when is a pudendal block used

A

late 2nd stage and 3rd stage of labor for pain (aka lacerations)

41
Q

where is a spinal block injected

A

directly into subarachnoid space to mix with cerebrospinal fluid
Positioning of mom important for administration for vaginal injection in lower back for C section injected higher in the back for nipple down to feet numbness (the medication goes down to ensure it doesn’t interfere with mom respirations)

42
Q

what should you give before a spinal block

A

IV fluid bolus

43
Q

what should you monitor after a spinal block

A

check BP, HR, RR, FHR ever 5-10 min

44
Q

what are the cons of a spinal block

A

mom cant feel to push and often requires assistance, increased uterine atony and postural puncture headache

45
Q

what are the pros of a spinal block

A

smaller amount of medicine, goof for muscle relaxation, minimal blood loss – spinal block works faster then an epidural shot

46
Q

what is a postdural headache and what are the ss

A

cerebral spinal fluid leaks into dura matter
 ss tell tell sign is they have a headchae in the upright position and if they lay down it goes away, can also have tinnitus, blurred vision, and photophobia

47
Q

what is the treatment for a postdural headache

A

bed rest in dark room, caffeine, and

48
Q

what are the maternal complications for spinal block

A

hypotension, decreased placental perfusion, ineffective breathing

49
Q

what are the pros of combo spinal-epidural analgesia

A

immediate pain relief, no loss of motor function so they can ambulate

50
Q

what are the cons of combo spinal epidural analgesia

A

increased risk for infection and postdural puncture headache

51
Q

what is general anesthsia and when is it used

A

induced unconsciousness, Used for unplanned/emergency c section, contraindications to epidural or spinal, or surgery needed for OB complications

52
Q

what are the cons of general anesthsia

A

increased blood loss (uterine relaxation), hypoxia, aspiration, fetal depression (because it can reach fetus in 2 minutes so you need to try and get the baby out in 2 min)

53
Q

what should you do before general anesthsia

A

IV premedicate with antacid, preoxygenated within 3-5min of 100% O2

54
Q

what are the nursing interventions for

A

OB Exam Two (8 decks)

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