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NURS 3800 > Pain > Flashcards

Pain Flashcards

0
Q

A laboring mother is very anxious, crying, and has a decreased perceptual field. You need her consent for the epidural. What should you do?

A

Wait until she calms down

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1
Q

What can influence pain perception

A 
Childbirth education
Cultural background
Fatigue/lack of sleep 
Personal significance 
Anxiety
Genetics
Previous experiences
Support
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2
Q

Does quietness mean there is no pain

A

No

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3
Q

What is effacement

A

Thinning of the cervical area

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4
Q

What are the three phases in the first stage of labor

A

Latent
Active
Transition

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5
Q

What phase of labor is the most painful in the first stage

A

Transition

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6
Q

What causes the pain during the first stage

A

Hypoxic uterine cells
Pressure-adjacent structures( due to child coming down through pelvis) distention of lower uterus
Dilation, effacement, stretching of uterus

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7
Q

When does the second stage of labor start

A

When mother is 10 cm dilated

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8
Q

What causes the pain in the second stage

A

Hypoxic uterine cells
Distention- vagina and perineum (child has to come through)
Pressure-adjacent structures
Lacerations

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9
Q

When does the third stage of labor begin

A

After child is born

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10
Q

What causes the pain during the third stage

A

Contractions (much less intense)

Cervical dilation

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11
Q

How long should it take for placenta to be delivers

A

5-30 ,minutes

If it takes longer they need to use a D&C (cervical scrapping) to get placenta out

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12
Q

What is the one thing that all non pharmacological pain management tools include

A

Education

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13
Q

What are the goals of breathing patterns

A

Oxygenate
Relaxation
Decrease pain and anxiety
Slow breathing to prevent hyperventilation

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14
Q

Lamaze

A

Mind prevention

Controlled breathing, toning, relaxation

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15
Q

Bradley

A

Partner coached
Slow controlled abdominal breathing
Teaching techniques directed towards coach vs mother

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16
Q

Dick-read

A

Believes fear built state of tension

Knowledge to decrease pain and abdominal breathing

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17
Q

Kitzinger

A

Strong believer in home births

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18
Q

Hypnobreathing

A

Hypnotized

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19
Q

Effleurage

A

Rhythmic stroking if abdomen during pain

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20
Q

What is sacral pressure

A

Back rubs during contractions

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21
Q

Should you encourage or discourage vocalization during labor?

A

Encourage

Can promote relaxation and help to relieve tension

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22
Q

What is the goal of analgesics during labor

A

Relieve pain
Minimal motor blockage

Use small amount possible because baby will get it too

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23
Q

What happens if analgesics are given too early?

Too late?

A

Early- May prolong labor

Late- little value and may cause neonatal respiratory depressions

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24
Q

Contraindications for an epidural

A 
Allergy
Compromised respiratory 
Drug dependence
Fetal heart rate out of normal range 
Meconium stained fluid
Infection/hypovolemia
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25
Q

Why is Meconium stained fluid a contraindication of epidural

A

That means the baby is already stressed and no more stress in the fetus is necessary

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26
Q

Does analgesia and anesthesia affect the fetus?

A

Yes, crosses placenta barrier

Fetal liver enzymes and renal system can’t metabolize drugs yet

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27
Q

Stress ____ amount of blood volume to fetus brain

A

Increases

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28
Q

Labor may ____ drug clearance and _____ half-life of some drugs

A

Decrease

Increase

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29
Q

Is oral route used for laboring mom as a means of medical administration

A

No

Very rarely

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30
Q

Who can prescribe analgesic agents

A

Physician
Anesthesiologist
CRNA
CNM

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31
Q

Who makes the decision about when to give analgesic

A

Staff nurse

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32
Q

What do you have to assess before giving analgesics

A 
Willingness or mother
Woman is uncomfortable
Stable VS
No allergies/ other contraindications
Fetal heart rate 110-160; reactive NST
Knowledge
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33
Q

When looking at results of an NST what is good; reactive or nonreactive

A

Reactive

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34
Q

What indicates a NST

A

Accelerations of 15 bpm lasting 15 seconds with each fetal movement

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35
Q

What does it mean if there are no accelerations in an NST

A

Bad results. Something could be wrong with fetus

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36
Q

What should you see with labor process after analgesics are given

A

Contractions: regular, increasing in intensity and duration
Cervical dilation
Station changing
Fetal presenting part descending

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37
Q

Side effects of analgesics

A

Decreased sensory perception
Maternal hypotension
Decreased fetal heart rate variability

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38
Q

Important things women need to know about pain relief medications before they are given

A 
Type
Route
Expected effects 
Implications for fetus/newborn 
Side effects 
Safety measures
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39
Q

What would you expect to find during assessment for labor progress in a woman where analgesia/anesthesia is given?

A

Contraction pattern to be regular, increasing intensity, and longer duration; cervical dilation; fetal presenting part descending showing no signs of distress; station of the fetal presenting part to be changing

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40
Q

What are some side effects that can occur when using analgesics during labor?

A

Maternal hypotension, lethargy, subdued mood, decreased sensory perception, decreased fetal HR variability, maternal and/or neonatal CNS depression, sleepiness, urinary retention (rare)

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41
Q

Why do some woman get IV fluids before getting analgesics

A

To prevent hypotension

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42
Q

When should you use analgesics cautiously

A

Hepatic function impairment, drug&alcohol dependent, physical dependence on benzodiazepines

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43
Q

What should the woman understand and know about pain relief meds before getting them

A

Type of medication administered, route of administration, expected effects of medication, implication for fetus/newborn, safety measures needed, side effect/complications

44
Q

When are sedatives rarely used

A

In true labor

45
Q

When are Barbiturates used?

A

Very latent phase, if used. You may send woman back home with these so she can sleep before delivery. Used if cervix is long, closed, thick

46
Q

What are Barbituates? Examples?

A

They are sedatives
Secobarbital (Seconal)
Ambien

47
Q

When are sedatives used?

A

Only used to decease anxiety, fear, apprehensiveness, and to promote sleep

48
Q

What are actions or Benzodiazepines

A

Minor tranquilizing, sedative effects

49
Q

Examples of benzodiazepines

A

Diazepam (Valium)

versed

50
Q

What should you assess in somebody getting benzodiazepines

A

Assess for CNS depression in mom and newborn

51
Q

Why may you give Versed?

A

Amnesic effect in OR procedures ; does not produce analgesia

52
Q

Why is Versed not advised prior to delivery?

A

To prevent low Apgars

53
Q

What is Benzodiazepine antidote/antagonist

A

Flumazenil

Use is controversial

54
Q

What are three types of sedatives

A

Barbiturates
Benzodiazepines
Ataractics

55
Q

What do Ataractics block

A

Action of histamines

56
Q

Examples of Atraractics?

A

promethazine (Phenergan)
prochlorperazine (Compazine)
hydroxyzine (Vistaril)

57
Q

How are Ataractics used? Why?

A

Used with opioid to decrease N&V and anxiety

58
Q

Concerns for fetus with use of sedatives?

A

Deceased FHR variability and CNS depression in neonate

59
Q

What are Narcotic Analgesics?

A

Opioids. They are drugs that enter the circulatory system and are distributed throughout the body and to the brain.

60
Q

How do narcotic analgesics reduce pain?

A

Decease transmission of pain impulses; bind to receptor site pathways and transmit the pain signal to the brain

61
Q

What are four examples of Narcotic Analgesics (opioids)

A

Butophanol tartrate (Stadol) -IV
Nalbuphine (Nubain)- IV
Hydrochloride (Demerol)
Fentanyl

62
Q

What is most commonly used opioid

A

Demerol

63
Q

What is it important to assess for with Nubain

A

Decreased FHR variability, respiratory depression, drowsiness, dizziness, blurred vision, diaphoresis, urinary urgency

64
Q

What should you assess for with Stadol?

A

Urinary retention and respiratory depression

65
Q

What is important about Butorphanol tartrate (Stadol)?

A

Crosses placenta and can cause respiratory depression. It is given IV

66
Q

Route Nubain is given?

A

IV

67
Q

What can reverse depressive effects of narcotics?

A

Naloxone (Narcan)

68
Q

What is drug of choice when depressant is unknown?

A

Naloxone (Narcan)

69
Q

Effects of Narcan

A

Little or no agonistic effect, little Pharmacologic activity in absence of narcotic agent

70
Q

What can Narcan do to a neonate if mother has been given narcotics before delivery, close to time of birth?

A

Can reverse neonatal respiratory depression

71
Q

What side effect can occur with Narcan although it is rarely seen

A

Urinary retention. Watch mom and babies output

72
Q

If there is a Narcotic addiction what will you see?

A

Extreme withdraw symptoms

73
Q

What may Agonist-Antagonist precipitate?

A

Drug withdraw in woman physically dependent on narcotics

74
Q

Is there loss of conscious with regional analgesia/anesthesia

A

No loss of conscious

75
Q

There is _____&______ blockage of impulses with Regional Analgesia/Anesthesia

A

Temporary and reversible

76
Q

Examples of Regional Analgesia

A

Epidural block, combined spinal-epidural, local infiltration, pudendal block, intrathecal (spinal)

77
Q

What happens with Regional Anesthesia?

A

Partial or complete loss of sensation below T8-T10 of spinal cord

78
Q

Side effects of local anesthetics

A

Hypotension, Palpitations, dizziness, apprehension, tinnitus, vertigo, pruitus, confusion, headache, metallic taste in mouth, N&V, seizures, coma, urinary retention

79
Q

Severe reactions with local anesthetics

A

Seldom seen, we don’t let it get to this pint

Loss of consciousness, coma, severe hypotension, bradycardia, respiratory and cardiac arrest

80
Q

Why and when do systematic toxic reactions most commonly occur ?

A

With an excessive dose because of too great a concentration or too large a volume

81
Q

When is lumbar epidural administered?

A

1st and 2nd stage pain relief, administered in active labor

82
Q

Where is lumbar epidural injected

A

Widest interspace below L2

83
Q

Where does the lumbar epidural go into?

A

The epidural space (between the dura mater&vertebral canal)

Not into the dura!

84
Q

Position for lumbar epidural

A

Left lateral best position. On side, back straight and vertical, shoulders square, upper leg prevented from rolling forward

85
Q

What does lumbar epidural block

A

Entire pelvis: uterus, cervix, vagina, perineum

86
Q

What are epidurals used for

A

Stage 1 through perineal repair

87
Q

Considerations with epidural

A

Maternal hypotension, N&V, respiratory depression

88
Q

What is it called when woman gets a epidural and she only feels pain on one side or a certain section

A

Spotty epidural

89
Q

Epidurals administered for

_______ or _______ or ________

A

One time l&d.
Patient controlled using Indwelling catheter
Combined Spinal-Epidural Analgesia (CSE)

90
Q

Characteristics of Combined Spinal-Epidural Analgesia (CSE)

A

Ability to bear down preserved; no loss of pushing reflex; motor power intact; can ambulate

91
Q

What are nursing considerations with a traditional epidural

A

Increased incidence of forceps use or vacuum extractor; loss of sensation/bearing down reflex; considerably less risk than general anesthesia, may slow labor, increased incidence of oxytocin use, assist mom to avoid supine hypotension

92
Q

Contraindications of regional epidurals

A

Risk of bleeding, coagulation disorders/defects, generalized sepsis, local infection @ needle site, back or spinal injury, maternal refusal

93
Q

What should you remember needs to be done before regional anesthetics

A

Hydrate well prior to procedure. (500-2000cc)

Helps prevent hypotension

94
Q

With general anesthetics what is mother at risk for

A

Hypotension, urinary retention, N&V, occasional HA or backache

95
Q

Where is spinal block injected into

A

Subarachnoid space

96
Q

What is advantage of spinal block

A

Immediate onset of anesthesia, smaller drug amount required

97
Q

What may occur with spinal block

A

Headache

98
Q

What should you know about pudenal block

A

Deep into lower side of vagina, blocks perineum and bathes pudenal nerve; for birth use forceps, vacuum extractor, episiotomy repair; No contraindications; coach client in pushing

99
Q

When is pudenal block done

A

Just prior to birth inside pudendal nerve

100
Q

What could be going on mother is complaining extra about pain in bottom

A

Could have hemorrhoids

101
Q

What is anesthesia for laceration or episiotomy repair

A

Local infiltration

102
Q

Does local infiltration require small or large amounts of agent

A

Large

103
Q

When is local infiltration administered

A

Just prior to birth

104
Q

What are side effects of local infiltration

A

No side effects for mom or newborn

105
Q

What is general anesthesia

A

Induced unconsciousness, not used a lot, IV or inhalation, used in a ER situation that does not allow for other techniques

106
Q

What are complications of general anesthesia

A

Fetal depression, failure to establish patent airway in woman, uterine relaxation which makes you watch for bleeding, maternal vomiting

107
Q

When inserting tube for general anesthesia watch _________ during rapid induction of anesthesia

A

Cricoid pressure

NURS 3800 (19 decks)

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