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OB Exam 2 > Maximizing Comfort in The Laboring Woman > Flashcards

Maximizing Comfort in The Laboring Woman Flashcards

1
Q

Visceral Pain

A
  • From cervical changes, distention of lower uterine segment, & uterine ischemia
  • 1st & 3rd stages of labor
  • Lower portion of abdomen
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2
Q

Referred Pain

A
  • Originated in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, & down thighs
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3
Q

Somatic Pain

A
  • Pain described as intense, sharp, burning, & localized
  • Results From:
    > distention/traction on the peritoneum & uterocervical supports during contractions
    > pressure against the bladder/rectum
    > stretching/distention of perineal tissues & pelvic floor to allow passage of fetus
    > lacerations of soft tissue
  • 2nd stage of labor
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4
Q

When is the woman free of pain during 1st stage of labor

A

Btwn contractions

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5
Q

Pain experienced during the 3rd stage of labor is similar to that of

A
  • Visceral pain
  • Results from placenta being delivered
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6
Q

Non-Pharmacologic Pain Management

A
  • Cutaneous Stimulation Strategies
    > counterpressure
    > effleurage (light massage)
    > TENS
  • Sensory Stimulation Strategies
    > breathing techniques
    > music
    > imagery
  • Cognitive Strategies
    > birth education: Lamaze/Bradley
  • These techniques are comparable and as effective as opioids
  • For the best results these will require practice
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7
Q

Non-Pharmacologic Pain Management - Breathing Technique

A

Maintaining a breathing rate tht is no more than twice her normal rate

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8
Q

Non-Pharmacologic Pain Management - Counterpressure

A

Steady pressure applied by a support person to the sacral area with a form object (tennis ball) or the fist or heel of hand

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9
Q

Non-Pharmacologic Pain Management - Effleurage

A

Light stroking, usually of the abdomen, in rhythm w/ breathing during contractions

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10
Q

Non-Pharmacologic Pain Management - Hydrotherapy Contraindications

A
  • Preterm labor
  • Continuous FHR monitoring
  • Vaginal bleeding
  • Infections
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11
Q

Factors Influencing Pain

physiologic, anxiety, experience

A
  • Physiologic Factors
    > fatigue affects coping
  • Anxiety
    > mild is normal
    > as anxiety/fear incrs muscle tension incrs & the effectiveness of uterine contractions dcr
  • Previous Experience
    > multiparas handle the pain better than women having their 1st
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12
Q

Gate-Control Theory of Pain

A
  • Its the idea of blocking the nerve pathways to the spinal cord
  • If less pain signal make it to brain then in theory you should feel less pain, trying to introduce the brain to positive stim by using 5 senses
  • Methods Used:
    > distraction: massage, guided imagery, music, hypnosis
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13
Q

Factors Influencing Pain

comfort, support, envir’t

A
  • Comfort
    > positive feedback, encourage,ent, & reminders tht labor & birth are normal processes
    > caring nursing approach & a supportive presence
  • Support
    > women w/ more support are less likely to use pain meds/epidural & are more likely to experience a spontaneous vag birth
  • Environment
    > homelike setting bc it’s comfortable
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14
Q

Pharmacologic Pain Management

when should this be implemented

A

Before pain is so severe tht carecholamines incr & labor is prolonged

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15
Q

Pharmacologic Pain Management - Sedatives

A
  • Causes
    > dcr anxiety
    > induce sleep
  • Avoid
    > barbiturate if birth is anticipated in 12-24hrs
  • Caution
    > these drugs can cross blood-brain barrier & effect fetus
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16
Q

Pharmacologic Pain Management - Anesthesia & Analgesia

A
  • Anesthesia
    > encompasses analgesia, amnesia, relaxation, & reflec acitvity
    > blocks pain by interruptingthe nerve impulse in brain
  • Analgesia
    > dcr pain w/out loss of consciousness
17
Q

How Opioids Affect Uterine Contractions

A
  • Inhibit uterine contractions
  • Should not be used until labor is well established
    > unless they are used to enhance therapeutic rest in prolonged early phase
  • For women in early phase of labor (1st stage) this may be an appropriate treatment to help cope & enhance rest
18
Q

Pharmacologic Pain Management - Systemic Analgesia

A

Readily cross placenta

19
Q

How Opioids Effect Baby

A
  • Absent/minimal FHR variability during labor
  • Respiratory depression
    > could require Narcan if its severe
20
Q

Pharmacologic Pain Management - Nerve Blocks (Caine)/Regional

A
  • Nerve Block
    > various methods labeled Neuraxial analgesic & anesthetic tech can be used in OB to produce a sensory/motor block over a certain region of body
  • Regional Analgesia
    > some pain relief/motor block
  • Regional Anesthesia
    > complete relief/motor block
21
Q

Pharmacologic Pain Management - Nerve Blocks

local perineal, pudendal

A
  • Local Perineal Infiltration Anesthesia
    > local block on perineum
    > either before the head is delivered or after in 4th stage of labor, episiotomy
  • Pudendal Nerve Block
    > does not relieve pain from uterine contractions
    > relieves pain in lower vagina, vulva, & perineum
    > helps w/ sensation felt during delivery
22
Q

Spinal Anesthesia

A
  • Used for
    > vaginal birth but not labor: T10 & down; hips to feet
    > scheduled c-section: T6 & down; tits to toes
  • Disadvantages
    > hypotension
    > impaired placental perfusion
    > ineffective breathing patterns
    > spinal headache
  • Advantages
    > ease of admin
    > absent of fetal hypoxia
23
Q

Spinal Anesthesia - Placement

A
  • Before
    > mother VS & a 20-30 minute fetal monitoring strip is obtained
    > bolus of LR 15-30 mins prior, no Dextrose (neonatal BG low)
  • After
    > q5-10min for fetus & mom
24
Q

Eqidural Anesthesia/Analgesia

A
  • Provides relief from uterine contractions & births
  • Vag/Cesarean births can be achieved by injecting a suitable local anesthetic agent into epidural space
  • “Opioid/Caine”
25
Q

Eqidural Anesthesia/Analgesia - Vaginal Birth Placement

A

A block from T10-S5 is required

26
Q

Eqidural Anesthesia/Analgesia - Cesarean Placement

A

A block from at least T8-S1

27
Q

Eqidural Anesthesia/Analgesia - Positioning, Advantages, Disadvantages, Contraindications

A
  • Positioning
    > curve back (Sims or bend over sitting up); same for spinal block
    > use a wedge under hip to prevent hypotension
  • Disadvantages
    > limited movement
    > CNS effect
    > hypotension: dcr perfusion to fetus
    > itchy from fentanyl
  • Contraindications
    > active hemorrhage
    > HTN
    > coagulopathy
    > incrd ICP
28
Q

General Anesthesia

A
  • Used if spinal/epidural block is contraindicated
  • Could be used in the event of a rapid birth if the situation warrants it
  • Rare for vaginal births
  • Sometimes for elective cesarean
29
Q

Cricoid Pressure

A
  • Apply pressure to cricoid cartilage to occlude esophagus & prevent aspiration of gastric contents
  • 10 mins to get baby out
30
Q

Nitrous Oxide

A
  • 50/50 mix w/ O2
  • Self administered
  • S/S of nausea & dizziness
    > does not affect fetus
31
Q

Care Management

A
  • Pain Assessment
    > 0-10 pain scale
    > oral 60 min reassess
    > IV under 10 min rapid absorption
32
Q

Non-Pharmacologic Interventions

A
  • Evaluate the effectiveness
  • Offer something different if its not working
33
Q

When do you Give IV Meds

A
  • IV route slowly during a contraction, this is to dcr fetal exposure
  • Uterine blood vessels are constricted which results in more of the med staying in the mothers vascular system
34
Q

Regional (Epidural/Spinal) Anesthesia Nursing Role

A
  • Assessment of mother/baby
  • Pause or stop the infusion to replace empty infusion syringes or infusion bags
  • Stop if safety concerns arise
  • Remove the catheter if trained to do so
35
Q

Informed Consent

A
  • You are the advocate
  • If they don’t understand inform provider
36
Q

Safety & General Care

A
  • Assess is crucial during this period
  • Stop pump after baby is delivered

OB Exam 2 (11 decks)

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