Conference One - Pain (Exam 2) 1

Question 1

Gate Control Theory

Answer 1

Perception of pain is modulated by interaction between different neurons

Question 2

Small-diameter sensory nerve fibers

Answer 2

Carry pain sensations to the brain

Question 3

Large-diameter sensory nerve fibers

Answer 3

Stimulation of these nerve fibers overrides conduction of impulses interpreted as painful (closes the gate, cancels out small-diameter sensory nerve fibers)

Question 4

Examples of large-diameter sensory nerve fiber stimulation

Answer 4

1. Touch relaxation
2. Sacral pressure
3. Massage
4. Hydrotherapy
5. Birthing Ball

Question 5

Non-Pharmacological management of pain techniques

Answer 5

1. Education/Prepartion for labor/pain/birth
2. Relaxation/Massage
3. Paced/Patterned Breathing
4. Focal Point/Imagery
5. Hydrotherapy
6. Position Changes
7. Ambulation
8. Birthing Ball

Question 6

Nubain (Nalbuphine)

Answer 6

Decreases perception of pain

• 10mg IV q 3-4 hours PRN
• Slow push, direct IV
• Maternal drowsing between contractions
• Readily crosses placental border
• Giving this medication during the latent phase may slow labor
• Administer with start of contraction to decrease transfer to placenta
• Potential indication for neonatal Narcan (respiratory depression)

Question 7

Epidural Anesthesia

Answer 7

• Sensory block in lower extremities
• Motor block to varying degrees
• Invasive procedure, not without risk
• Impacts feasibility of many non-pharmacologic pain management options

Question 8

Nursing Considerations for Epidural Anesthesia

Answer 8

• Maternal Hypotension
  
  • Impaired uteroplacental perfustion leads to FHR abnormalities r/t hypoxia
    
    • Continuous EFM
    • Compensatory IV fluid bolus in advance of anesthesia
• Bladder Distention
  
  • Straight Catheter, sometimes a foley
• Prolonged Second Stage
  
  • Delayed ability to integrate muscle memory
  • Laboring down/passive descent