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

Exam 1 (Pain Management) Flashcards

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
Hydrotherapy - Whirlpool
Promotes relaxation & decreases anxiety
26
Transcutaneous Electrical Nerve Stimulation
Two electrodes placed on the thoracic and sacral provide continuous low-intensity electrical impulses which facilitate the release of endorphins.
27
Acupressure/Acupuncture
Pressure, heat, cold or needles applied to acupressure/acupuncture points (tsubos). These points have increases receptors and electrical conductivity. Overall pain sensations decreases.
28
Heat and Cold Therapy
Warmed blankets - increase blood flow | Cold compresses - relieve muscle spasms.
29
Touch and Massage
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
Hypnosis
Focuses on relaxation, and diminishing fear, anxiety & perception of pain.
31
Biofeedback
Recognition of physical signals (increased resp, hr, etc.) associated with labor can trigger specific responses to heighten relaxation.
32
Aromatherapy
Fragrances to heighten relaxation
33
Intradermal Water Block
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
Sedatives
Relieve anxiety & induce sleep. | Includes barbiturates, phenothiazines, and benzodiazepines.
35
Barbiturates
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
Phenothiazines (Phenergan)
Don’t decrease pain but decreases anxiety and apprehension | Potentiate opioids
37
Benzodiazepines (ativan, valium)
Potentiate opioids
38
Analgesia
Alleviation of pain sensation or raising of pain threshold without loss of consciousness
39
Systemic analgesia
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
Anesthesia
Encompasses analgesia, amnesia & relaxation. Abolishes pain by interrupts nerve impulses to brain. May be partial or complete. With or without loss of consciousness.
41
Systemic analgesia (Opioid Agonist Analgesics [Narcotics] Severe Pain)
Severe, persistent or recurrent pain. Examples: Dilaudid, Demerol, Sublimaze, Sufenta Euphoria Birth 4 hrs after administration of any opioid. Naloxone - antidote.
42
Systemic analgesia (Opioid Agonist-Antagonist Analgesics
Stadol (butorphanol) and Nubain (nalbuphine) - adequate analgesia without respiratory depression. Less nausea & vomiting. Not for women with opioid dependence.
43
What will block all opioid receptors in opioid users?
Opioid Agonist-Antagonist Analgesics
44
Systemic Analgesia (Opioid Antagonists)
Reverse CNS depressant side effects Antidote for opioid agonists. Narcan (naloxone) is example. Give cautiously in drug dependent women.
45
Nerve Block Analgesia & Anesthesia
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
Local Perineal infiltration anesthesia
Commonly used for episiotomies | Local anesthetic is injected directly into vaginal tissue
47
Pudendal Nerve Block
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
What is perineal infiltration anesthesia mainly used for???
For rips on the vagina during birthing.
49
Spinal Anesthesia
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
Epidural Anesthesia/Analgesia
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
What is a common SE of Epidural?
Hypotension
52
How is hypotension prevented with epidural?
500-1000 ml bolus before getting epidural to keep BP up.
53
How is Epidural given??
Infused intermittently by push, continuously by pump, or PCA style by pump.
54
Is respiratory arrest a danger during epidural?
Yes, especially if block is too high.
55
Can PDPH occur during Epidural?
Yes, Epidural can be the cause of PDPH!
56
Combined Spinal-Epidural Analgesia
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
Epidural & Intrathecal Opioids
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
What is the most common side effect of spinal and epidural anesthesia?
Hypotension
59
What are some contraindications (spinals & epidurals)?
``` Antepartum hemorrhage Anticoagulant therapy or bleeding disorder Infection at injection site Allergy to anesthetic drug Maternal refusal Some maternal cardiac conditions ```
60
Name spinal and Epidural Anesthesia Adveres Effects?
Maternal hypotension | Decreased placental perfusion
61
Describe maternal hypotension caused by spinal and epidural anesthesia.
20% decrease from baseline or < 100 systolic | Fetal bradycardia
62
Describe decreased placental perfusion caused by spinal and epidural anesthesia.
Fetal bradycardia | Decreased beat-to-beat fetal heart rate variability
63
What are some interventions for adverse effects caused by spinal epidural anesthesia?
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
General Anesthesia
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
What are some goals in the recovery room after general anesthesia?
Maintain patent airway & cardiopulmonary function | Prevent postpartum hemorrhage
66
Cricoid
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
What is appropriate timing of drug administration?
Waiting until 4-5 cm dilated for drugs so as not to slow labor progress.
68
What is the best way to give IV medications?
Give slowly during each contraction over 3-5 contractions.
69
Spinal anesthesia
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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