Intrapartum 2 (Pain Management) Flashcards
Beta-endorphines are released by which gland? What do they do?
Released/secreted by the pituitary gland that act on the CNS and PNS to reduce pain
They are associated with feelings of euphoria and analgesia
-The pain threshold may increase as beta-endorphin levels increase enabling patients in labour to better tolerate pain
What happens to the mothers blood pressure in response to pain during labour?
Increases during contractions and may increase with pain
When is sensory pain greater for nulliparous patients? Why?
Sensory pain for nulliparous patients is often greater than that for multiparous patients during early latent labour (dilation less than 4 cm) because their reproductive tract structures are less supple.
Examples of sensory stimulation strategies that can be used as pain relief during labour?
Aromatherapy
Breathing techniques
Music
Imagery
Use of focal points
What must the nurse assess for when taking into account how culture can influence labour pain?
The nurse must assess the patient for the physiological effects of pain and listen to the words the patient uses to describe the sensory and affective qualities of the pain.
Examples of non-pharmalogical Cutaneous Stimulation Strategies for pain relief during labour
Counterpressure
Effleurage (light massage)
Therapeutic touch and massage
Walking
Rocking
Changing positions
Application of heat or cold
Transcutaneous electrical nerve stimulation (TENS)
Acupressure/acupuncture
Hydrotherapy (showers, bath)
Intradermal water block
What are some maternal complications of a epidural?
Maternal complications: *hypotension, N&V, fever, pruritis, intravascular injection, respiratory depression
What does a visual pain scale allow women in labour to do?
A visual analog scale allows the woman to indicate on a
line how severe or intense she perceives her pain to be
At what point during labour should opioid agonist analgesics be administered?
They should not be administered until labour is well established because they can inhibit uterine contractions
*Only exception to this is unless they are being used to enhance therapeutic rest during a prolonged latent phase of labour
What kind of disadvantage/negative effect can an epidural have on the fetus during labour?
Effects on fetus during labour: fetal distress secondary to maternal hypotension
What can occur in the immediate postpartum period? (This is a disadvantage of an epidural)
Urinary retention and stress incontinence can occur in the immediate postpartum period
What is continuous labour support recommended for? What does it aim to provide?
“Recommended for all women in active labour. Each labour unit should aim to provide the opportunity for each woman to receive continuous 1-to-1 labour support”
What kind of pharmalogical pain managament can a labouring patient have in the second stage of labour?
Nerve block analgesia/anaesthesia
*Local infiltration anaesthesia
*Pudendal block
*Epidural (block) analgesia and anaesthesia
*Spinal (block) anaesthesia
*Nitrous oxide
When can Nitrous Oxide (Entonox) be used during labour and in combination with?
It can be used during the first and second stages of labour and can be used in combination with other nonpharmacological and pharmacological measures for pain relief
What does the gate-control theory state about pain?
According to this theory, pain sensations travel along sensory nerve pathways to the brain, but only a limited number of sensations, or messages, can travel through these nerve pathways at one time.
Using distraction techniques, such as massage or stroking, music, focal points, and imagery, reduces or completely blocks the capacity of nerve pathways to transmit pain.
What emotional (affective) expressions of pain are seen during labour?
Such changes include increasing anxiety with lessened perceptual field, writhing, crying, groaning, gesturing (hand clenching and wringing), and excessive muscular excitability throughout the body.
What does continuous labour support include?
Includes continuous presence, emotional support, comfort measures, advocacy, information & advice
What can urinary retention be related to? (Think with the use of epidurals)
This temporary difficulty in urinary elimination could be related not only to the effects of the epidural block and catheterization done in labour but also to the increased duration of labour and need for forceps- or vacuum-assisted birth associated with the block.
How does hypotension occur as a result of with epidurals?
Hypotension as a result of sympathetic blockade can occur in about 14% of patients who receive epidural and 70% of patients who receive spinal anaesthesia during labour.
What is the nurse permitted to with when a patient has an epidural?
*Monitor the status of the patient receiving regional anaesthesia, the fetus, and the progress of labour
*Replace empty infusion syringes or bags with the same medication and concentration
*Stop the infusion if there is a safety concern or the patient has given birth
*Remove the catheter if properly educated to do so
*Initiate emergency measures if the need arises
*Communicate clinical assessments and changes in patient status to obstetrical and anaesthesia care providers
In some institutions the registered nurse may also alter the rate of medication infusion and administer bolus doses as ordered
What is considered to be the most helpful intervention in enhancing comfort during labour?
Using a caring nursing approach and providing a continuous supportive presence
What happens to the mothers cardiac output in response to pain during labour?
Increases with pain from contractions & anxiety
What specific opioid medication use is increasing for labourpain?
Sufentanil – use is increasing
What kind of pain is felt during the second stage of labour?
Somatic pain
What kind of pain predominates during the first stage of labour?
Visceral pain
During the first stage of labour where does pain originate from?
*Dilation of the cervix
During the first stage of labour, pain originates from the uterus and cervix.
Uterine contractions cause cervical effacement and dilation
Where is visceral pain generated from?
Visceral pain is generated from distension of the lower uterine segment, stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures (e.g., fallopian tubes, ovaries, ligaments) and nerves, and uterine ischemia that predominates during the first stage of labour
Examples of Systemic Analgesia that can be used for pain management during labour?
Opioid agonist analgesics: Fentanyl, Sufentanil, Morphine
Opioid agonist-antagonist analgesics:
Nalbuphine
(Nubane)
Opioid
antagonists:
Naloxone (Narcan
How does a PCA work?
With PCA, the patient self-administers small doses of an opioid analgesic intravenously by using a pump programmed for dose and frequency.
What can further delay gastric emptying during labour?
Use of opioid analgesics
What are the 5 benefits to providing continuous labour support (CLS)
1.) Increased likelihood of a vaginal delivery
2.) Decreased risk of a caesarean section
3.) Reduced use of epidural analgesia
4.) Increased Apgar score (This test checks a baby’s heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed)
5.) Increased maternal satisfaction
What is important for the nurse to recognize when thinking how culture influences labour pains
It is important for the nurse to recognize that, although a patient’s behaviour in response to pain may vary according to their cultural background, it may not accurately reflect the intensity of the pain being experienced.