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NU 330 > Chapter 8: Pain Management (only) > Flashcards

Chapter 8: Pain Management (only) Flashcards

1
Q

non-pharmacological ways to manage (pain) discomfort

A
  • childbirth preparation
  • relaxation and breathing techniques
  • effleurage
  • thermal stimulation
  • mental stimulation
  • support person
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2
Q

pain management: complementary therapy

A
  • aromatherapy- essential oils
  • massage
  • birthing ball
  • hydrotherapy
  • self-hypnosis
  • music therapy
  • acupuncture
  • sterile water injections
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3
Q

pharmacological management of labor pain

A
  • analgesia
  • nitrous oxide
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4
Q

principles of using analgesia

A
  1. labor should be established
  2. medication should provide relief to mother with minimal risk to baby
  3. neonatal depression may occur if medication is given within an hour of delivery
  4. women with hx of drug abuse may have lessened effect from pain meds and may need higher doses
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5
Q

epidural anethesia

A

placement of a very small catheter and injection of local anesthesia and/or analgesia between 3rd and 5th vertebrae into the epidural space

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6
Q

what is the most common form of pain relief during labor in the US?

A

epidural anesthesia

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7
Q

nursing responsibilities for patients receiving regional anesthesia

A
  • verify informed consent has been obtained by the anesthesia provider
  • assess fetal status and maternal baseline, including pain level, BP, pulse, RR, temperature, O2 status, labor progress
  • admin an IV bolus as ordered by the provider
  • conduct a time-out before regional anesthesia admin
  • provide patient education on the selected pain control method
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8
Q

anesthesia during labor

A
  • regional anesthesia
    -epidural
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9
Q

nursing care of the woman during regional anesthesia placement

A
  • assist the woman to an appropriate position, either sitting, lateral, or pendant position
  • assist with maintaining the position and with breathing and relaxation
  • monitor for adverse maternal reactions during and immediately after test dose
  • monitor for adverse fetal reactions during initiation medication
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10
Q

epidural placement

A

in the epidural space between the 3rd and 5th vertebrae in the lumbar region

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11
Q

which analgesics are used during labor?

A
  • morphine sulfate (or opioid)
  • butorphanol (or mixed opioid agonist or antagonist)
  • sublimaze
  • fentanyl (or opioid)
  • nalbuphine (or mixed opioid agonist or antagonist)
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12
Q

physiologic birth is also called

A

normal birth

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13
Q

physiologic birth definition

A

birth that is powered by the innate human capacity of the woman and fetus

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14
Q

physiologic birth includes

A

spontaneous vaginal birth at term, with minimal technologic and pharmacologic interventions

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15
Q

physiologic birth is followed by

A

skin-to-skin contact and immediate breastfeeding

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16
Q

benefits to physiologic birth

A
  • decreased interference with the birth process
  • decreased length of labor
  • decreased use of analgesia and anesthesia
  • decreased operative birth
  • decreased newborn complications associated with elective inductions of labor and operative births
  • increased effectiveness of pushing
  • increased maternal satisfaction and empowerment
  • enhanced bonding
  • enhanced breastfeeding
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17
Q

perinatal nurse role

A
  • assess maternal/fetal well-being
  • administer procedures and monitor for effectiveness
  • interventions to assist with a laboring mom’s physical, emotional, and spiritual needs
  • rendering care related to the birth process
  • initiate newborn care
  • providing care during early PP period
  • advocating
  • teaching/education
  • communicating with other health care providers
  • documentation
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18
Q

HypnoBirthing

A
  • helps mom align with their own innate capacity to be able to give birth gently, comfortably, powerfully and joyfully
  • no promises of a sensation free birth
  • respects the rights and wishes of couple to birth the way that they want rather than by anyone else’s standards or timeline
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19
Q

what is the intention of HypnoBirthing

A

give power back to laboring mothers and fathers that has been taken away from them

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20
Q

HypnoBirthing was established by

A

Marie Mongan

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21
Q

why is fear during childbirth bad for the mother?

A
  • she cannot relax
  • tension in muscles throughout body
  • intense tension causes pain in the uterine muscles which make the uterus work inefficiently, doesn’t allow uterus to open properly, causes lots of pain
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22
Q

why is removing fear important

A

no fear = no tension = no pain

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23
Q

what are some ways to remove fear from laboring mothers? (hint: exercises)

A
  • lemon exercise
  • pen drop exercise
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24
Q

what do endorphins do for laboring moms?

A

they act as the body’s natural relaxant
- slow down the firing rate of neurons which decreased pain sensations

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25
Q

in the absence of fear, how strong are endorphins compared to narcotics?

A

the body’s endorphins are 200x stronger than narcotics when allowed to be released from the pituitary in the absence of fear

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26
Q

uterine muscles are designed to

A

carry an infant to term and assist the infant to be born

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27
Q

how many layers of the uterus are there

A

3, but we are only concerned with 2: the outer layer and inner circular muscles

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28
Q

outer layer of the uterine muscles

A

-vertically aligned with the baby
- thickest and strongest on top, tighten and draw up the relaxed circular muscles at the neck of the uterus to nudge the baby down

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29
Q

inner circular muscles of the uterine muscles

A
  • horizontally circular around the baby (cervix)
  • thickest just above the neck of the uterus
  • relax and thin out to allow the baby to emerge
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30
Q

when do the outer layer and inner circular muscle layer of the uterine muscles work well together?

A

when mom is relaxed

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31
Q

fear triggers what system

A

the ANS (autonomic nervous system)

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32
Q

what is the job of the ANS

A
  • to interpret messages that it receives and then relay that to the rest of the body systems
  • responses are involuntary
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33
Q

what are the two parts of the ANS

A
  • sympathetic: panic room
  • parasympathetic: healing room
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34
Q

sympathetic nervous system

A
  • triggered by fear, stress, startled
  • fight, flight or freeze response
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35
Q

sympathetic nervous system response (signs/symptoms)

A
  • pupils dilate
  • HR increases
  • RR increases
  • digestive processes are suspended (vomiting)
  • closes arteries to organs not needed for defense, ie uterus
  • halts labor as it preps body to deal with emergency
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36
Q

does the body know the difference between a real danger and a perceived danger

A

no, it acts the same way for both

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37
Q

what is referred to as the body’s “emergency system”

A

sympathetic nervous system

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38
Q

parasympathetic nervous system

A

keeps the body in a state of balance and harmony

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39
Q

parasympathetic nervous system response

A
  • slows HR
  • slows breathing
  • reduces stimulation
  • slows the firing or harmful neuropeptides

*happy mom = happy baby

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40
Q

if mom approaches birth with unresolved fear and stress, what stressor hormone is released?

A

catecholomine

41
Q

where can negative messages about birth and the birth experience come from?

A
  • family
  • movie and tv images
  • scary birthing scenes
  • baby shower horror stories
  • labor nurses
42
Q

what does the body do when there is fear surrounding birth?

A

it can’t fight or flight so it freezes

43
Q

what causes the “freeze” response during labor

A

the blood flow to the uterus is decreased
- causes uterine muscles to constrict and tighten
- cervical muscles stop opening
- the vertical muscles try to draw up and back but there is tension and constriction between the two muscle groups, which causes the pain that laboring women feel

44
Q

(FTP) failure to progress is equivalent to

A

(FTP) fear tension pain

45
Q

hypnosis

A

a natural state that you drift in and out of every day

  • in a hypnotic state, you are hyperaware of yourself
46
Q

how many conscious thoughts can we hold at a time? what do we do as a result of this?

A
  • can only hold one conscious thought at a time
  • train our brains to go into autopilot so we can think of other things, (i.e. drive a car, grooming, eating)
47
Q

hypnosis: conditioned responses

A

responses to certain situations that we have worked up in our mind and our body responds accordingly
ie being pulled over by the police, sex, going on an amusement ride

48
Q

what is the most important aspect of hypnosis regarding our body’s response to birthing?

A
  • for every suggestion, thought, or emotion there is a corresponding physiological response within the body
  • whatever mom chooses to accept as real or “perceives” as real, the body will act accordingly
49
Q

law of motivation

A

when the mind is highly motivated, the body will respond accordingly

50
Q

HypnoBirthing Techniques

A
  • breathing
  • relaxation
  • visualization
  • deepening
51
Q

breathing: types

A
  • sleep breathing
  • slow breathing
  • birth breathing
52
Q

sleep breathing

A
  • type of breathing you use to slip into a deep state of relaxation or sleep
  • the breathing done in-between the surges and while at rest
  • Eyes gently closed, breathe in through mouth to a count of 4 and feel the breath go to the back of the throat and then out to a count of 8 through the nose
53
Q

slow breathing

A
  • VERY important because it is the breathing that we do with the surges
  • Goal is to make the breath as long in as it is out.
  • With eyes closed, the entire body relaxed focusing on breathing in slowly as the uterus draws up to the top of the abdomen and then breathing it back down slowly and controlled. In to the count of 20 out to the count of 20.
54
Q

birth breathing

A
  • also called “slanted J” breathing as this is the “shape” it should take
  • assists with the natural expulsion reflex of the body to move baby down gently to crowning and birth It is not pushing, that is counter productive and slows birth
  • a short quick breath in, move the air to the back of the throat and then down the body to the vaginal outlet
55
Q

what type of breathing is also referred to as (slanted) J breathing?

A

birth breathing

56
Q

calming behaviors to promote mom’s relaxation

A
  • letting her choose clothes to birth in
  • soft music or nature sounds
  • soft voice
  • dim lighting
  • essential oils diffused or applied topically
57
Q

progressive relaxation

A
  • deep inhalation, picturing numbers counting down and moving relaxation throughout the body systems
58
Q

(relaxation) anchors

A
  • creating a lasting imprint with an association of a gesture, sound, image or touch
59
Q

light touch massage

A
  • most beneficial if someone has had limited training in natural birth techniques
  • great for fathers or partners to perform
  • can do this on multiple different areas with the patient in different position
  • a light touch, over a three-square-foot area of sensitive skin area is a massive stimulation, contraction the central nervous system and the peripheral nervous system
60
Q

light touch massage: objective

A
  • To stimulate and reprogram the internal mechanism in the brain without drugs.
  • To release endorphins needed to stifle pain, reduce stress and eliminate back strain
61
Q

light touch massage: how

A
  • a light touch is administered to the skin over the neck, spine and upper arms.
  • produces a massive sensation, stimulating the nerves in that area.
62
Q

light touch massage: method

A
  • a repetitive light stroke, applied simultaneously on both sides of the entire spine
  • using light, kinesthetic, vertical “V” and horizontal “8” strokes to the upper part of the torso (neck, back and arms).
63
Q

what is the Reticular Formation responsible for?

A
  • filtering the impulses entering the system and regulating the body’s level of arousal, from a state of deep sleep at one extreme to a state of intense mental activity at the other
64
Q

when is light touch massage very effectively administered?

A

when laboring mom wants to change into a kneeling position

65
Q

the light touch V

A
  • The birth companion places his/her hands on the small of the back to become centered, then with the backside of the fingers meeting at the base of the spine, lightly using fingernails draw up, out and across creating a shallow pattern of vertical V
66
Q

the “8”

A
  • Starting at the base of the spine, criss-cross hands at the center of the back to create horizontal figure “8” pattern
  • Light touch should be administered with the back of the thumbnails, leading all the way to the skull. The hands are brought around the neck and sides of ears
67
Q

what makes light touch special for labor

A
  • touching breasts and ears is allowed
68
Q

what are the most common practices of essential oils

A
  • aromatic diffusion
  • topical application
  • dietary consumption
69
Q

popular essential oils for spiritual focus

A
  • sacred frankincense
  • white angelica
  • live your passion
  • inspiration
70
Q

essential oils to rediscover peace, balance, joy

A

joy
- lavender
- orange
peace and calming
- peppermint
- jasmine

71
Q

essential oils that offer natural support for wellness

A
  • lavender
  • peppermint
  • thieves essential oil blend
  • frankincense
  • R.C.
  • PanAway
72
Q

what are some other names for guided imagery

A
  • guided meditation
  • visualization
  • mental rehearsal
  • guided self-hypnosis
73
Q

guided imagery is

A

a gentle but powerful technique that focuses the imagination in proactive, positive ways
- involves all the senses, not just vision

74
Q

what are the 3 principles of Guided Imagery

A
  1. the mind-body connection
  2. the altered state
  3. locus of control
75
Q

imagery tips

A
  • works best in a permissive, unforced atmosphere
  • engage all senses
  • music can increase the effects of imagery
  • don’t have to be a “believer” to make it work
  • touch is a powerful accompaniment
  • aches and pains are often gone after imagery meditation
76
Q

interferences with physiologic birth

A
  • IOL for no medical indication
  • oxytocin or AROM to “speed it up”
  • unnecessary IV fluids and boluses
  • epidurals
  • hospital culture that is not supportive to normal labor
  • nurses having limited knowledge of labor support techniques
77
Q

medically managed labor includes

A
  • AROM
  • oxytocin IOL or augmentation in absence of medical indication
  • cytotec
  • cervidil
  • balloon induction
  • manual removal of placenta in the absence of an indication
78
Q

cesarean section rates

A

as of 2011, 1/3 women delivered via c/s

79
Q

factors contributing to the increase in cesarean section rates

A
  • rise in maternal age
  • obesity
  • cultural considerations
80
Q

Low risk women are safer and have a lower mortality rate when delivering their infants _____

A

vaginally compared to a c/s

81
Q

modifiable hospital culture

A
  • Communication practices between nurse, patient and providers
  • Nurses being powerful advocates for birth choice of patients
  • Hospital Education available to support birth choice
  • Hospital support for natural early labor techniques with portable monitors, ambulation, partner support, birth balls and hydrotherapy options
82
Q

underused interventions

A
  • Midwives and Family Physicians
  • Continuous Labor Support
  • Measures to Relieve Pain, Bring Comfort, and/or Promote Progress during Labor
  • Delayed and Spontaneous Pushing
  • Non-supine Positions for Giving Birth
  • Delayed Cord Clamping in Full-Term and Preterm Newborns
  • Early Skin-to-Skin Contact
  • Breastfeeding and Interventions to Promote Its Initiation and Duration
83
Q

what are some factors working against physiologic birth?

A
  • Lack of a National Standardized Set of Maternity Performance Measures
  • A Payment System That Incurs Perverse Incentives
  • Malpractice Concerns
  • Specialist Orientation Care Typical for Healthy, Low-Risk Mothers and Babies
  • Current Maternity Practice Guidelines Excessively Reliant on Opinion
  • Lack/Loss of Professional Core Knowledge/Skills for Optimal Childbirth
  • Harms and Iatrogenesis Often Not Adequately Understood/Considered
  • Knowledge Transfer and Application Challenging
  • Pressure from Industry
  • Increased Harm/Expense and More Entrenched Problems to Result If Policy Intervention Delayed
  • Media Depiction of the Childbirth Experience Often Limited
  • Informed Consent Processes Often Inadequate
84
Q

promoting best practices

A
  • Implement hard stop policies to prevent elective induction of labor prior to 39 weeks gestation. Hard stop policies require compliance with the guidelines by all providers.
  • Only Induce labor before 41 0/7 weeks for evidence-based maternal or fetal indications and ideally with nulliparous women with Bishop score > 8 or multiparous women with Bishop score > 6.2
  • Use cervical ripening methods of labor induction for a woman with an unfavorable cervix.
  • Provide prenatal education to women to increase awareness of the possible benefits and harms and evidence-based indications for induced labor.
  • Offer external cephalic version to women with a breech or transverse fetus at term.
85
Q

birth satisfaction increases with

A

physiologic birth

  • also increased when the choice made is mom’s
86
Q

PTSD is more likely when a patient is

A

pressured into a choice that she did not come to on her own: IOL, c/s, epidural

  • PTSD symptoms decrease when mom’s physiologic birth is supported
87
Q

what three things are known to improve patient satisfaction with a mom who just delivered a child?

A
  • amount of support from their caregivers
  • quality of relationship with her caregivers
  • level of involvement in her labor process
88
Q

which fibers: small or large diameter, feel acute pain v. sensation?

A
  • large diameter fibers: sensations
  • small diameter fiber: acute pain
89
Q

women who attend childbirth prep classes report ____

A

greater birth experiences

90
Q

what is the difference between a spinal and regional epidural anesthesia?

A
  • spinal is for c/s (higher up)
  • regional is for vaginal delivery (just hips down)
91
Q

adverse affects of epidural

A
  • hyperthermia
  • systemic toxicity
  • urinary retention
  • pruritus
92
Q

nursing care after regional anesthesia placement

A
  • assess fetal response frequently to regional anesthesia. assist with maternal positioning and avoid the supine position
  • assess uterine activity every 5 minutes for the first 15 minutes
  • assess for urinary retention and bladder distention q4h and assist with bladder emptying on bedpan
  • assess maternal BP after initiation or re-bolus of a regional block, including PCEA
  • monitor the woman for signs of sedation and respiratory depression
  • perform intermittent urinary catheterization using a straight cath if she is unable to void spontaneously
  • BP should be assessed at least q5 min for the first 15 min, then repeated at 30 min, and 1 hour after procedure
  • assess level of motor blockade hourly throughout the period of analgesia or anesthesia
  • if frequent bladder catheterizations are indicated, consider the use of indwelling urinary catheter
  • resolve maternal hypotension, according to provider orders and facility protocol, such as lateral positioning, and administer additional crystalloid fluid boluses or vasopressors
  • monitor maternal temp q2-4h after anesthesia
  • assess for sedation level, N/V, pruritus
93
Q

popular types of childbirth education classes

A
  • lamaze
  • the Bradley method
  • the international childbirth education association (ICEA)
  • hypnobirthing
  • birthing from within
  • hospital-based birthing classes
94
Q

childbirth education classes: Lamaze

A
  • offers childbirth education classes grounded in the idea that women have an innate ability to give birth
  • letting labor begin on its own, freedom of movement in labor, labor support, no routine interventions, spontaneous pushing in non-supine positions, and keeping mother and baby together
95
Q

childbirth education classes: the ICEA

A
  • classes sponsored by the ICEA do not emphasize any one approach to childbirth but offer general information about the process of labor and birth
  • they discuss natural childbirth, teach various methods of dealing with the pain of labor and birth, and present the options available for pain birthing
96
Q

childbirth education classes: birthing from within

A
  • a holistic approach to childbirth, Birthing from Within offers patients a general informative teaching experience
  • activities and processes teach parents specific skills to holistically inform and prepare them for birth
97
Q

childbirth education classes: hospital-based birthing classes

A
  • many hospitals offer birthing classes for parents planning to give birth at their facility
  • these classes may follow a specific method or a combination of methods, with the goal of preparing the mother and birth partner for labor and postpartum
98
Q

childbirth education classes: the Bradley method

A
  • emphasizes natural childbirth with the birth partner as the coach
  • this method encourages concentrated awareness that works through pain rather than blocking it
  • parents are taught deep abdominal breathing, massage, and an understanding of the labor and delivery process
99
Q

which essential oil helps with nausea during labor?

A

peppermint oil

NU 330 (18 decks)

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