Maternity Nursing Chap 10 Flashcards
________ pain originates in the body organs during labor and birth. This type of pain results from cervical changes and uterine ischemia. It is located over the lower portion of the abdomen and radiates to the lumbar area of the back and down the thighs.
-visceral
________ pain is well localized. During labor and birth this type of pain is experienced as perineal discomfort that results from stretching and distention of perineal tissue to allow passage of the fetus and from traction on the peritoneum and uterocervical supports during contractions.
-somatic
_______ pain is felt in areas of the body other than the area of pain origin. Pain originating in the abdominal viscera is felt in the abdominal wall, lumbosacral area of the back, iliac crest, gluteal area, thighs, and lower back.
-referred
The _________ theory of pain is based on the principle that pain sensations travel along sensory nerve pathways to the brain but only a limited number of sensations or messages can travel through these never pathways at one time. Pain relief techniques based on this theory include massage or stroking, music, imagery, and concentration on breathing and relaxation techniques.
-gate control
_________ are endogenous opioids secreted by the pituitary gland that act on the central and peripheral nervous systems to reduce pain.
-endorphins
Three major childbirth preparation methods taught in the US are __________, ___________, and __________.
- dick Read
- lamaze
- Bradley
Breathing techniques provide ________, thereby reducing the perception of pain and helping the woman maintain control throughout contractions. Slow paced breathing is breathing at approximately half the woman’s normal breathing rate. It is usually the first technique used in early labor.
-distraction
As contractions increase in frequency and intensity, chest breathing is used, with breathing becoming more _________ in depth and increasing to about twice the normal breathing rate.
-shallow
A _________ should begin and end each breathing technique and contraction.
-cleansing breath
A breathing technique using a pattern of breaths and puffs in a ratio of 4:1, 6:1, or 8:1 is used to enhance concentration during the _________ phase of the first stage of labor. An undesirable effect of this type of breathing might be hyperventilation or rapid, deep respirations, which can result in respiratory alkalosis, as exhibited by the symptoms of lightheadedness, dizziness, tingling of fingers, or circumoral numbness. It can be overcome by having the woman breathe into a paper bag or cupped hand. This enables the woman to rebreathe carbon dioxide and replace the bicarbonate ions.
-transition
__________, or light stroking of the abdomen or other body part in rhythm with breathing during contractions and counterpressure, or steady pressure against the lower back especially during back labor, are two
-effleurage
Factors influencing response to pain:
- culture
- anxiety and fear
- previous experience with pain and with childbirth
- childbirth preparation activities
- comfort measures
- secretion of endorphins
- support
- history of substance abuse
- history of sexual abuse
- pain and tolerance
- perception
Abolition of pain perception by interrupting nerve impulses going to the brain (loss of sensation, partial or complete, and sometimes loss of consciousness occurs)?
-anesthesia
Method to repair a tear in the dura mater around the spinal cord as a result of spinal anesthesia?
-epidural blood patch causing
Single injection subarachnoid anesthesia useful for pain control during birth but not for labor?
-spinal block/anesthesia
Systemic analgesic that provides analgesia without significant maternal or neonatal respiratory depression?
-opioid agonist antagonist
Used for rapid perineal anesthesia for performing and repairing an episiotomy?
-local infiltration anesthesia
Medication such as a barbiturate that can be used to relieve anxiety and induce sleep in prodromal or early latent labor?
-sedative
Analgesic potentiators such as tranquilizers?
-ataractics
Drug that reverses effects of opioids including neonatal narcosis (central nervous system depression of the newborn)?
-opioid antagonist
Medications such as opioid agonists that are administered intramuscularly or intravenously for pain relief during labor?
-systemic analgesia
Alleviation of pain sensation or raising of the pain threshold without loss of consciousness?
-analgesia
Relief from pain of uterine contractions and birth by injecting a local anesthetic and/or opioid agonist such as fentanyl into the peridural space?
-epidural block
Anesthetic that eliminates pain in the lower vagina, vulva, and perineum, making it useful for episiotomy birth, and forceps- or vacuum-assisted birth?
-pudendal block
Factors influencing effect of systemic analgesics on fetus:
- maternal dosage
- pharmacokinetics of the specific drug
- route
- time when administered during labor
Fetal effects of systemic analgesics:
- central nervous system (CNS) depression as a result of the direct effect of the drug when it crosses the placenta and/or the indirect effect of maternal hypotension and hypoventilation resulting from the action of the drug on maternal functions
- CNS depression slows the fetal heart rate, decreases variability, and leads to respiratory depression and hypoxia
True or False: Somatic pain occurs as a result of perineal stretching and pressure exerted by the presenting part on the pelvic organs and structures.
True
True or False: A woman’s perception of her birth experience as “good” or “bad” is influenced by the degree to which she believes she has met her personal goals related to coping with pain effectively.
True
True or False: Water therapy can be used even if the laboring woman’s membranes are ruptured.
True
True or False: Water therapy can worsen the pain associated with “back” labor.
False: soothing, relaxing, and comforting
True or False: Barbituates given without an analgesic when a laboring woman is experiencing pain can magnify pain perception because the woman’s normal coping mechanisms may be blunted.
True
True or False: Intramuscular administration of analgesics during labor offers a more predictable onset of pain relief.
False:
True or False: Naloxone (Narcan) is contraindicated if a woman has an opioid dependency because it may cause symptoms of withdrawl.
True
True or False: Before initiating her epidural anesthesia, a woman should be adequately hydrated using an intravenous (IV) solution of 5% glucose in water.
False:
True or False: Epidural anesthesia is useful as a pain relief measure for both labor and birth.
True
True or False: Keeping the woman in a flat position for at least 8 hours after birth is the most effective way to prevent headaches following a spinal block.
False:
True or False: The woman can be assisted into a sitting position for the induction of both spinal anesthesia and lumbar epidural block.
True
True or False: Maternal hypotension is a major adverse reaction to both spinal anesthesia and epidural block
True
The use of ataractics can potentiate the action of analgesics. An ataractic that the nurse might expect to give to a laboring woman would be:
a. naloxone (Narcan)
b. hydroxyzine (Vistaril)
c. butorphanol tartrate (Stadol)
d. fentanyl (Sublimaze)
b. hydroxyzine (Vistaril)
The doctor has ordered meperidine (Demerol) 25 mg IV q2-3h prn for pain associated with labor. In fulfilling this order, the nurse should know that:
a. the onset of the effect of this analgesic after IV administration is approximately 10 mins
b. the dosage of the analgesic is too high for IV administration, necessitating a new order
c. respiratory depression of the woman or fetus is not a concern with this analgesic
d. the newborn should be observed for respiratory depression if birth occurs within 4 hours after administration
d. the newborn should be observed for respiratory depression if birth occurs within 4 hours after administration
An anesthesiologist is preparing to begin a continuous epidural block using a combination of local anesthetic and narcotic analgesic as a pain relief measure for a laboring woman. A nursing measure related to this type of nerve block would be to:
a. assist the woman into a modified Sims or upright position with her back curved
b. keep the woman in a semirecumbent position after administration to ensure equal distribution of the pharmacologic agents
c. assess the woman for headaches, especially after birth
d. assist the woman to the bathroom to urinate at least every 2 hours during labor to prevent bladder distention
a. assist the woman into a modified Sims or upright position with her back curved
