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Maternal Child Nursing (Exam 1) > Exam 1 (Pain Management) > Flashcards

Exam 1 (Pain Management) Flashcards

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1
Q

Visceral Pain

A

Throbs, aches, and is generalized
Caused from cervical changes, distention of lower uterine segment, uterine ischemia
Primarily occurs in 1st stage of labor
Located over lower abdomen

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2
Q

Somatic Pain

A

Intense, sharp, burning, well localized pain
Resulting from stretching & distention of perineal tissues
Also from distention & traction on peritoneum & uterocervical supports/lacerations of soft tissues
2nd stage

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3
Q

Referred Pain

A

Pain from uterus radiates to abdominal wall, lumbosacral are, iliac crests, gluteal area, down the thighs.

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4
Q

Physical Consequences of Pain

A 
Increased catecholemine levels
Increased BP & heart rate
Hyperventilation (respiratory alkalosis)
Pallor & diaphoresis
Increased gastric acidity
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5
Q

Emotional Consequences of Pain

A 
Fatigue
Anxiety
Lessened perceptual field
Writhing
Crying
Groaning
Gesturing
Entire body muscular excitability
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6
Q

Factors Influencing Pain Response (Physiologic Factors)

A

Hx of Dysmenorrhea

Endorphins

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7
Q

dysmenorrhea

A

Painful Period.

Increased pain in labor d/t increased prostaglandin level

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8
Q

Endorphins

A

Endogenous opioids secreted by pituitary gland – act on CNS & PNS to reduce pain

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9
Q

Factor Influencing Pain Response (Culture)

A

Based on cultural expectations

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10
Q

Factors Influencing Pain Response (Anxiety)

A

Increased levels of anxiety increase catecholamine secretion = more pain stimuli reaching the brain. Anxiety starts a pattern of ineffective laboring.

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11
Q

Factors Influencing Pain Response (Previous Experience)

A

Nulliparous - increased general sensory pain

Multiparous - greater sensory pain in 2nd stage

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12
Q

Gate-Control Theory

A

Pain messages to brain are impeded by other focused messages being sent. Only so many can travel at one time. Is a method of distraction to block pain stimuli signals from reaching brain.

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13
Q

Factors Influencing Pain Response (Comfort)

A

Most important to this is a good nurse and support person

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14
Q

Factors Influencing Pain Response (Support)

A

Continuous support during L&D will yield better outcome of mother & baby.
Ability to make decisions about labor influences pt experience.
Overall support helps relieve pain and improve outcomes.

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15
Q

Factors Influencing Pain Response (Environment)

A

Accommodate woman as much as possible with familiar home items

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16
Q

Nonpharmacologic Management of Discomfort

A

Childbirth Preparation

Lamaze, Dick-Read method & Bradley methods most common in the US.

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17
Q

Bradley methods

A

No medical attention

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18
Q

Relaxation

A

Allows women conserve energy for birth.
Uses attention focusing and distraction.
Bring a favorite object
Breathing is key

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19
Q

Imagery

A

Focus on her “Happy Place”

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20
Q

Conscious Breathing

A

Support person tells woman when to breathe.
Begin with deep cleansing breath and end with final deep cleansing breath with paced breaths in between.
Signs of hyperventilation: light-headedness, dizziness, tingling of fingers, or circumoral numbness.
Paper bag
Rate no more than twice the normal respiratory rate.
Panting breaths - prevents pushing before cervix fully dilated.

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21
Q

Around the mouth numbness indicates?

A

Hyperventilation

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22
Q

Effleurage

A

Light abdominal stroking in rhythm with contractions.

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23
Q

Counter-pressure

A

Steady pressure applied to sacral area by support person with fist or heel of hand that assists in relieving back pain from OP fetal positions.

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24
Q

Music

A

Relaxes patient reducing stress, anxiety, and perception of pain

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25
Q

Hydrotherapy - Whirlpool

A

Promotes relaxation & decreases anxiety

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26
Q

Transcutaneous Electrical Nerve Stimulation

A

Two electrodes placed on the thoracic and sacral provide continuous low-intensity electrical impulses which facilitate the release of endorphins.

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27
Q

Acupressure/Acupuncture

A

Pressure, heat, cold or needles applied to acupressure/acupuncture points (tsubos). These points have increases receptors and electrical conductivity. Overall pain sensations decreases.

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28
Q

Heat and Cold Therapy

A

Warmed blankets - increase blood flow

Cold compresses - relieve muscle spasms.

29
Q

Touch and Massage

A

Nurse should ensure client’s wishes to be touched.

Therapeutic touch and healing touch are used to align & balance human energy field, therefore promoting self healing.

30
Q

Hypnosis

A

Focuses on relaxation, and diminishing fear, anxiety & perception of pain.

31
Q

Biofeedback

A

Recognition of physical signals (increased resp, hr, etc.) associated with labor can trigger specific responses to heighten relaxation.

32
Q

Aromatherapy

A

Fragrances to heighten relaxation

33
Q

Intradermal Water Block

A

The injection of small amounts of sterile water by using small (25g) needle in four locations on lower back can relieve back pain.
Lasts 45 minutes to 2 hrs.
Can be repeated as needed.

34
Q

Sedatives

A

Relieve anxiety & induce sleep.

Includes barbiturates, phenothiazines, and benzodiazepines.

35
Q

Barbiturates

A

Can cause respiratory depression in woman & newborn
Should be used only in early labor
Don’t give without analgesic b/c will actually increase pain

36
Q

Phenothiazines (Phenergan)

A

Don’t decrease pain but decreases anxiety and apprehension

Potentiate opioids

37
Q

Benzodiazepines (ativan, valium)

A

Potentiate opioids

38
Q

Analgesia

A

Alleviation of pain sensation or raising of pain threshold without loss of consciousness

39
Q

Systemic analgesia

A

Crosses maternal blood-brain barrier to provide analgesic
Can cause respiratory depression and decreased alertness in mother & neonate.
Higher doses - greater effect.
Doses close to delivery heightens effect in neonate.
IV preferred to IM due to predictability.

40
Q

Anesthesia

A

Encompasses analgesia, amnesia & relaxation.
Abolishes pain by interrupts nerve impulses to brain.
May be partial or complete.
With or without loss of consciousness.

41
Q

Systemic analgesia (Opioid Agonist Analgesics [Narcotics] Severe Pain)

A

Severe, persistent or recurrent pain.
Examples: Dilaudid, Demerol, Sublimaze, Sufenta
Euphoria
Birth 4 hrs after administration of any opioid.
Naloxone - antidote.

42
Q

Systemic analgesia (Opioid Agonist-Antagonist Analgesics

A

Stadol (butorphanol) and Nubain (nalbuphine) - adequate analgesia without respiratory depression.
Less nausea & vomiting.
Not for women with opioid dependence.

43
Q

What will block all opioid receptors in opioid users?

A

Opioid Agonist-Antagonist Analgesics

44
Q

Systemic Analgesia (Opioid Antagonists)

A

Reverse CNS depressant side effects
Antidote for opioid agonists.
Narcan (naloxone) is example.
Give cautiously in drug dependent women.

45
Q

Nerve Block Analgesia & Anesthesia

A

Local anesthetic agents are used for this
Agents are in the same family as cocaine.
Usually end in “caine”.
Temporarily interrupts conduction of nerve impulses

46
Q

Local Perineal infiltration anesthesia

A

Commonly used for episiotomies

Local anesthetic is injected directly into vaginal tissue

47
Q

Pudendal Nerve Block

A

Second stage labor, episiotomy, & birth
Does not relieve contraction pain.
Does relieve pain in lower vagina, vulva, and perineum.
Given transvaginally
No significant maternal or fetal side effects.

48
Q

What is perineal infiltration anesthesia mainly used for???

A

For rips on the vagina during birthing.

49
Q

Spinal Anesthesia

A

Anesthetic solution + fentanyl injected into 3rd, 4th, or 5th lumbar interspace into subarachnoid space.
Common for ceserean births
Anesthesia from nipple line to feet for cesareans or from hips to feet for vaginal delivery.
Marked hypotension, impaired placental perfusion and ineffective breathing pattern.
Postdural puncture headache - Blood patch
Avoid lifting, straining, coughing, tub baths, or swimming x 2 days.

50
Q

Epidural Anesthesia/Analgesia

A

Most common pain relief method in US
Local anesthetic + an opioid injected into the epidural space
T10 to S5 - vaginal birth
T8 to S1 - cesarean
Monitor mother and baby carefully (VS, fetal heart rate).
Infused intermittently by push, continuously by pump, or PCA style by pump.
Respiratory arrest is a danger if block is too high.
Ability to move lower extremities impaired.
Increased duration of labor common & instrumental assisted delivery sometimes needed.
PDPH can occur

51
Q

What is a common SE of Epidural?

A

Hypotension

52
Q

How is hypotension prevented with epidural?

A

500-1000 ml bolus before getting epidural to keep BP up.

53
Q

How is Epidural given??

A

Infused intermittently by push, continuously by pump, or PCA style by pump.

54
Q

Is respiratory arrest a danger during epidural?

A

Yes, especially if block is too high.

55
Q

Can PDPH occur during Epidural?

A

Yes, Epidural can be the cause of PDPH!

56
Q

Combined Spinal-Epidural Analgesia

A

Lower doses of opioids and local anesthetic agents.
Blocks pain without impairing the ability to move.
“Walking epidural”
Abnormal sensations in the legs and lower extremities.
Allows for bearing down with delivery.

57
Q

Epidural & Intrathecal Opioids

A

Epidural or spinal opioid given without local anesthetic.
Do not alter VS or cause severe hypotension.
Feel contractions but not pain.
Nausea, vomiting, pruritus, urinary retention, repiratory depression.

58
Q

What is the most common side effect of spinal and epidural anesthesia?

A

Hypotension

59
Q

What are some contraindications (spinals & epidurals)?

A 
Antepartum hemorrhage
Anticoagulant therapy or bleeding disorder
Infection at injection site
Allergy to anesthetic drug
Maternal refusal
Some maternal cardiac conditions
60
Q

Name spinal and Epidural Anesthesia Adveres Effects?

A

Maternal hypotension

Decreased placental perfusion

61
Q

Describe maternal hypotension caused by spinal and epidural anesthesia.

A

20% decrease from baseline or < 100 systolic

Fetal bradycardia

62
Q

Describe decreased placental perfusion caused by spinal and epidural anesthesia.

A

Fetal bradycardia

Decreased beat-to-beat fetal heart rate variability

63
Q

What are some interventions for adverse effects caused by spinal epidural anesthesia?

A

Turn mother to side with hip wedge to displace uterus
Administer IV at prescribed rate
O2 at 10-12 L/min via face mask
Elevate legs
Notify provider or anesthesiologist
Give IV vasopressor (Ephedrine) as ordered
Monitor VS q 5 min – especially FHR and BP until stable

64
Q

General Anesthesia

A

Puts to sleep
NPO & IV necessary (Aspiration pneumonia)
Oral antacid given to decrease gastric acid
Hip wedge should be placed to displace uterus
Cricoid pressure before intubation
Goals in recovery room are:
Maintain patent airway & cardiopulmonary function
Prevent postpartum hemorrhage

65
Q

What are some goals in the recovery room after general anesthesia?

A

Maintain patent airway & cardiopulmonary function

Prevent postpartum hemorrhage

66
Q

Cricoid

A

Grab around the base of the trachea:
Keeps them from aspirating by the gag reflex
Helps physicians see the local cords so they won’t hit them.

67
Q

What is appropriate timing of drug administration?

A

Waiting until 4-5 cm dilated for drugs so as not to slow labor progress.

68
Q

What is the best way to give IV medications?

A

Give slowly during each contraction over 3-5 contractions.

69
Q

Spinal anesthesia

A

Raise side rails & have call light available.
Change position q 1 hr.
Assess for return of sensory & motor function.
Preload with ordered IV fluid to prevent hypotension.
Monitor bladder function and have client empty bladder or get order for foley catheter.
Ensure that O2 and suction are available.

Maternal Child Nursing (Exam 1) (11 decks)

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