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Obstetrics > Comfort and Labour Support > Flashcards

Comfort and Labour Support Flashcards

1
Q

5 effects of RN as labour support

A
  1. increased likelihood of spontaneous birth
  2. decreased analgesia use
  3. decreased c-section, forceps, vacuum
  4. decreased incidence of 5 min APGAR
  5. increased satisfaction with experience
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2
Q

Doula

A

Not licensed; someone who provides emotional support and comfort measures during labour and delivery

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3
Q

Registered Midwives

A

Licensed professionals; work as specialists in normal birth and have privileges to do deliveries in the hospital or, if appropriate, in the comfort of the client’s own home

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4
Q

5 categories of labour support

A
  1. physical
  2. emotional
  3. instructional
  4. advocacy
  5. partner/coach care
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5
Q

Pain vs Suffering

A

Pain: a physical sensation

Suffering: an emotional sensation

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6
Q

The Three R’s

A

Successful laboring women have these 3 characteristics in common to cope well:
1. Relaxation between contractions

  1. Rhythm that helps them cope
  2. Ritual that can be included while going through the rhythm
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7
Q

Mental Activity Comfort Measures

A

distraction, meditation, non-focussed awareness, imagery, hypnosis

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8
Q

Basic need comfort measures

A

hygiene, nutrition, hydration

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9
Q

3 examples of massage techniques

A
  1. double hip squeeze
  2. criss cross
  3. breaking the popsicle
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10
Q

Why is hydrotherapy beneficial during the active stage of labour

A

Warmth and buoyancy supports uterus
1. reduced surgical birth rates
2. shorter second stage
3. reduced analgesic
4. lower perineal trauma

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11
Q

What position compared to recumbent reduced the duration of labour, risk of c section, less need of epidural, and less chance of NICU?

A

Walking and upright position

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12
Q

What are the 4 benefits of the birthing ball?

A
  1. increases balance
  2. counter pressure on perineum
  3. eases back pain
  4. widens pelvic outlet
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13
Q

What labour activities can occur if a patient has mobility limitations?

A

The rollover
Q30 min

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14
Q

What are sterile water injections

A

Pain reduction; 0.1ml of sterile water intradermally in 4 locations lasting 4 hours

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15
Q

What is a consideration of systemic drugs used in pain relief for labour?

A

Cross placental barrier by simple diffusion

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16
Q

The ideal labor analgesic is

A
  1. safe for client and baby
  2. rapid
  3. ease of admin
  4. maternal sense of control
  5. minimal side effects
  6. no effect on ambulation, voiding, progress
  7. effective for all stages
17
Q

What are the 2 parenteral opioids used for labour pain?

A

Morphine and Fentanyl

18
Q

Describe the use of fentanyl vs morphine in labour pain

A

Morphine: earlier on/if labour is progressing slower (nulliparous) because of longer onset and half life

Fentanyl: given later on/if labour is progressing faster (multipiarous) because shorter onset/half-life

19
Q

Why is demerol out of favour for pain relief?

A

Stays in fetal circulation for up to 90 hours

20
Q

What synergistic medications are necessary to have ordered when using opioid pain relief?

A

anti-emetics r/t nauseating effects of opioids

Narcan for fetal respiratory depression

21
Q

What are the advantages of nitrous oxide for pain relief?

A

(inhaled analgesic)

  • rapid effect with patient awake
  • no effect on contractions
  • minimal neonatal depression
  • self adminstaration
22
Q

Disadvantages of nitrous oxide as pain relief

A
  • decreased effectiveness with prolonged use (only used in later stages of active labour/second stage)
  • major risk of general anesthesia if not self administered
  • only breath in during contractions; room air when not
23
Q

Advantages of epidural (4)

A
  1. not systemic
  2. effective for all stages
  3. increased sense of control
  4. allow for ambulation, little effect on pushing, less interference with voiding
24
Q

Epidural side effects/complications (8)

A
  1. hypotension
  2. unanticipated spinal injection
  3. bladder dysfunction/difficulty ambulating
  4. inability to push
  5. shivering
  6. N/V
  7. neuro complications
  8. ineffective block
25
Q

Why is hypotension the most significant side effect of epidural?

A

Can cause fetal bradycardia

26
Q

Contraindications to epidural

A

§ Patient refusal
§ Significant bleeding or coagulopathy
§ Systemic sepsis
§ Spinal injury / conditions affecting lower spine (relative)
§ Sensitivity to local anesthetics
§ Unavailable personnel / equipment

27
Q

Define epidural

A

Anesthetic and/or analgesic injected into epidural space L4-L5 to produce little/no feeling from T4-T10

Usually continuous infusion

28
Q

Nursing care for epidurals

A
  1. baseline vitals and FHR then q5min x 20 after insertion
  2. IV access with 500-1000ml bolus for hypotension
  3. attend to client position
  4. Dermatomes 30-60min (t4-T10)
  5. Motor function/bromage score q1h
  6. attention to bladder function
29
Q

What is a spinal block, advantages, and usual use?

A

Lock analgesia into spinal canal for quick onset and longer duration

Administered higher for c section and lower for vaginal birth

30
Q

What is a pudendal block>

A

Local anesthetic injected into pudendal nerve in vagina near the end of labour and has no effect on fetus/progress of labour

31
Q

What is local infiltration?

A

Lidocaine injected into perineum for relief for episiotomy incision or laceratin repair

No effect on client or fetus

32
Q

4 Major Complications of Pain Relief in Labour

A
  1. fetal depression
  2. uterine relaxation
  3. vomiting/aspiration
  4. difficult/failed intubation

Obstetrics (12 decks)

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