Chapter 7 Pain Flashcards
how can you promote decent of fetus and ease pain
position changes ( walking, standing, squatting, hand and knees, etc.) – in early labor we want them to ambulate
what is the preferred position for when laying in the bed
left side laying to promote fetal circulation and oxygenation
what is a pain threshold
least amount of pain necessary for a person to perceive it as pain
what is pain tolerance
ability of an individual to sustain pain once felt
what are the sources of pain
: dilation/stretching of cervix, reduced uterine blood supply during contractions, pressure of fetus on pelvis, stretching of vagina and perineum
what is the gate control theory
- pain sensation travels along sensory nerve peathways to brain, but only a certain number of messages can go at once
how does relaxation work
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
what is effleurage
light touch distracts from discomfort – circular motions around the belly and thighs
what is counter pressure
heel of the hand or fist applied to moms sacral area, very good for babies who are sunny side up
what is hydrotherapy
- use of warm water to promote comfort/relaxation like shower or soaking in the tub the warm water helps decrease muscle tension
how does hot/cold therapy work
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
how does TENs unit work
produces counterirritation on nociceptors to relieve pain
how does breathing therapy work
it should be practiced before labor, each breathing pattern and ends with cleansing breath can use deep breathing, paced breathing, or patterned paced breathing
what should you do before giving a medication and why
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
when and why are Sedatives/ antiemetics used
: used during early/ latent phase to relieve anxiety and help to aide in sleep
when and why are Barbiturates used
like secobarbitol sodium in early/latent labor to side in sleep
when and why are benzos used
like diazepam and lorazepam used in early labor to treat anxiety
when and why are H1-receptors used
like hydroxyzine, promethazine in early labor used as an antiemetic
what is an Analgesia
relief from pain – less pain or no pain
what is an anesthesia
partial or complete loss of sensation with or without loss of consciousness
what are the cons of anesthesia/Analgesia
affects mom and baby- respiratory depression, delayed suckling response, decrease alertness
how do you want to give oxytocin antagonist analgesia and why
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
if you give oxytocin antagonist analgesia too close to delivery what could happen
in the transition phase it could cause fetal respiratory depression and cardiac depression
if you give oxytocin antagonist analgesia too early to delivery what could happen
like in the latent phase then it could slow labor progression
if you give oxytocin antagonist analgesia at the right time what happens and when is the right time
1 hour or greater then 4 hours before birth – helps labor progress and decrease pain
what are the pros of anesthesia/Analgesia
decreased respiratory depression and less n/v
who do you not want to give oxytocin antagonist analgesia to
to moms with opioid dependance because it may precipice mother and baby withdrawl syndrome
what is nitrous oxide and how does it work
inhaled gas, self administered by patient, 50/50 blend oxygen and nitrous oxide, Pain relief and decreased anxiety, gives state of euphoria
what are the adverse effect to mom using nitrous oxide and how can you prevent it
: n/v, restlessness, anxiety – to prevent ask mom if she has had any reaction to laughing gas before
what are the adverse fetal effects of nitrous oxide
none
what is regional anesthesia and what must you have on stand by
Regional anesthesia: complete pain relief and motor block, Must have epinephrine, antihistamines, oxygen avalible for emergencies
what is a reginal analgesia
provides some pain relief and motor block but not complete
what is an epidural the combo of
analgesia and anesthesia
where is the edidural space and how long does it take for the epidural to work
located outside dura matter, takes about 20-30 minutes to work
before giving an epidural what should you give
IV bolus fluid
what position is mom in to give an epidural
in side laying or sitting upright
how does a test dose work for an epidural
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
what are the pros of an epidural
maternal relaxation, enhanced comfort and pain relief, little blood loss, minimal fetal effects
what are the cons of an epidural
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
when is a pudendal block used
late 2nd stage and 3rd stage of labor for pain (aka lacerations)
where is a spinal block injected
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)
what should you give before a spinal block
IV fluid bolus
what should you monitor after a spinal block
check BP, HR, RR, FHR ever 5-10 min
what are the cons of a spinal block
mom cant feel to push and often requires assistance, increased uterine atony and postural puncture headache
what are the pros of a spinal block
smaller amount of medicine, goof for muscle relaxation, minimal blood loss – spinal block works faster then an epidural shot
what is a postdural headache and what are the ss
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
what is the treatment for a postdural headache
bed rest in dark room, caffeine, and
what are the maternal complications for spinal block
hypotension, decreased placental perfusion, ineffective breathing
what are the pros of combo spinal-epidural analgesia
immediate pain relief, no loss of motor function so they can ambulate
what are the cons of combo spinal epidural analgesia
increased risk for infection and postdural puncture headache
what is general anesthsia and when is it used
induced unconsciousness, Used for unplanned/emergency c section, contraindications to epidural or spinal, or surgery needed for OB complications
what are the cons of general anesthsia
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)
what should you do before general anesthsia
IV premedicate with antacid, preoxygenated within 3-5min of 100% O2
what are the nursing interventions for
