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
1
Q
What can influence pain perception
A
Childbirth education Cultural background Fatigue/lack of sleep Personal significance Anxiety Genetics Previous experiences Support
2
Q
Does quietness mean there is no pain
A
No
3
Q
What is effacement
A
Thinning of the cervical area
4
Q
What are the three phases in the first stage of labor
A
Latent
Active
Transition
5
Q
What phase of labor is the most painful in the first stage
A
Transition
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
7
Q
When does the second stage of labor start
A
When mother is 10 cm dilated
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
9
Q
When does the third stage of labor begin
A
After child is born
10
Q
What causes the pain during the third stage
A
Contractions (much less intense)
Cervical dilation
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
12
Q
What is the one thing that all non pharmacological pain management tools include
A
Education
13
Q
What are the goals of breathing patterns
A
Oxygenate
Relaxation
Decrease pain and anxiety
Slow breathing to prevent hyperventilation
14
Q
Lamaze
A
Mind prevention
Controlled breathing, toning, relaxation
15
Q
Bradley
A
Partner coached
Slow controlled abdominal breathing
Teaching techniques directed towards coach vs mother
16
Q
Dick-read
A
Believes fear built state of tension
Knowledge to decrease pain and abdominal breathing
17
Q
Kitzinger
A
Strong believer in home births
18
Q
Hypnobreathing
A
Hypnotized
19
Q
Effleurage
A
Rhythmic stroking if abdomen during pain
20
Q
What is sacral pressure
A
Back rubs during contractions
21
Q
Should you encourage or discourage vocalization during labor?
A
Encourage
Can promote relaxation and help to relieve tension
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
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
24
Contraindications for an epidural
```
Allergy
Compromised respiratory
Drug dependence
Fetal heart rate out of normal range
Meconium stained fluid
Infection/hypovolemia
```
25
Why is Meconium stained fluid a contraindication of epidural
That means the baby is already stressed and no more stress in the fetus is necessary
26
Does analgesia and anesthesia affect the fetus?
Yes, crosses placenta barrier
Fetal liver enzymes and renal system can't metabolize drugs yet
27
Stress ____ amount of blood volume to fetus brain
Increases
28
Labor may ____ drug clearance and _____ half-life of some drugs
Decrease
Increase
29
Is oral route used for laboring mom as a means of medical administration
No
Very rarely
30
Who can prescribe analgesic agents
Physician
Anesthesiologist
CRNA
CNM
31
Who makes the decision about when to give analgesic
Staff nurse
32
What do you have to assess before giving analgesics
```
Willingness or mother
Woman is uncomfortable
Stable VS
No allergies/ other contraindications
Fetal heart rate 110-160; reactive NST
Knowledge
```
33
When looking at results of an NST what is good; reactive or nonreactive
Reactive
34
What indicates a NST
Accelerations of 15 bpm lasting 15 seconds with each fetal movement
35
What does it mean if there are no accelerations in an NST
Bad results. Something could be wrong with fetus
36
What should you see with labor process after analgesics are given
Contractions: regular, increasing in intensity and duration
Cervical dilation
Station changing
Fetal presenting part descending
37
Side effects of analgesics
Decreased sensory perception
Maternal hypotension
Decreased fetal heart rate variability
38
Important things women need to know about pain relief medications before they are given
```
Type
Route
Expected effects
Implications for fetus/newborn
Side effects
Safety measures
```
39
What would you expect to find during assessment for labor progress in a woman where analgesia/anesthesia is given?
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
40
What are some side effects that can occur when using analgesics during labor?
Maternal hypotension, lethargy, subdued mood, decreased sensory perception, decreased fetal HR variability, maternal and/or neonatal CNS depression, sleepiness, urinary retention (rare)
41
Why do some woman get IV fluids before getting analgesics
To prevent hypotension
42
When should you use analgesics cautiously
Hepatic function impairment, drug&alcohol dependent, physical dependence on benzodiazepines
43
What should the woman understand and know about pain relief meds before getting them
Type of medication administered, route of administration, expected effects of medication, implication for fetus/newborn, safety measures needed, side effect/complications
44
When are sedatives rarely used
In true labor
45
When are Barbiturates used?
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
What are Barbituates? Examples?
They are sedatives
Secobarbital (Seconal)
Ambien
47
When are sedatives used?
Only used to decease anxiety, fear, apprehensiveness, and to promote sleep
48
What are actions or Benzodiazepines
Minor tranquilizing, sedative effects
49
Examples of benzodiazepines
Diazepam (Valium)
| versed
50
What should you assess in somebody getting benzodiazepines
Assess for CNS depression in mom and newborn
51
Why may you give Versed?
Amnesic effect in OR procedures ; does not produce analgesia
52
Why is Versed not advised prior to delivery?
To prevent low Apgars
53
What is Benzodiazepine antidote/antagonist
Flumazenil
| Use is controversial
54
What are three types of sedatives
Barbiturates
Benzodiazepines
Ataractics
55
What do Ataractics block
Action of histamines
56
Examples of Atraractics?
promethazine (Phenergan)
prochlorperazine (Compazine)
hydroxyzine (Vistaril)
57
How are Ataractics used? Why?
Used with opioid to decrease N&V and anxiety
58
Concerns for fetus with use of sedatives?
Deceased FHR variability and CNS depression in neonate
59
What are Narcotic Analgesics?
Opioids. They are drugs that enter the circulatory system and are distributed throughout the body and to the brain.
60
How do narcotic analgesics reduce pain?
Decease transmission of pain impulses; bind to receptor site pathways and transmit the pain signal to the brain
61
What are four examples of Narcotic Analgesics (opioids)
Butophanol tartrate (Stadol) -IV
Nalbuphine (Nubain)- IV
Hydrochloride (Demerol)
Fentanyl
62
What is most commonly used opioid
Demerol
63
What is it important to assess for with Nubain
Decreased FHR variability, respiratory depression, drowsiness, dizziness, blurred vision, diaphoresis, urinary urgency
64
What should you assess for with Stadol?
Urinary retention and respiratory depression
65
What is important about Butorphanol tartrate (Stadol)?
Crosses placenta and can cause respiratory depression. It is given IV
66
Route Nubain is given?
IV
67
What can reverse depressive effects of narcotics?
Naloxone (Narcan)
68
What is drug of choice when depressant is unknown?
Naloxone (Narcan)
69
Effects of Narcan
Little or no agonistic effect, little Pharmacologic activity in absence of narcotic agent
70
What can Narcan do to a neonate if mother has been given narcotics before delivery, close to time of birth?
Can reverse neonatal respiratory depression
71
What side effect can occur with Narcan although it is rarely seen
Urinary retention. Watch mom and babies output
72
If there is a Narcotic addiction what will you see?
Extreme withdraw symptoms
73
What may Agonist-Antagonist precipitate?
Drug withdraw in woman physically dependent on narcotics
74
Is there loss of conscious with regional analgesia/anesthesia
No loss of conscious
75
There is _____&______ blockage of impulses with Regional Analgesia/Anesthesia
Temporary and reversible
76
Examples of Regional Analgesia
Epidural block, combined spinal-epidural, local infiltration, pudendal block, intrathecal (spinal)
77
What happens with Regional Anesthesia?
Partial or complete loss of sensation below T8-T10 of spinal cord
78
Side effects of local anesthetics
Hypotension, Palpitations, dizziness, apprehension, tinnitus, vertigo, pruitus, confusion, headache, metallic taste in mouth, N&V, seizures, coma, urinary retention
79
Severe reactions with local anesthetics
Seldom seen, we don't let it get to this pint
| Loss of consciousness, coma, severe hypotension, bradycardia, respiratory and cardiac arrest
80
Why and when do systematic toxic reactions most commonly occur ?
With an excessive dose because of too great a concentration or too large a volume
81
When is lumbar epidural administered?
1st and 2nd stage pain relief, administered in active labor
82
Where is lumbar epidural injected
Widest interspace below L2
83
Where does the lumbar epidural go into?
The epidural space (between the dura mater&vertebral canal)
| Not into the dura!
84
Position for lumbar epidural
Left lateral best position. On side, back straight and vertical, shoulders square, upper leg prevented from rolling forward
85
What does lumbar epidural block
Entire pelvis: uterus, cervix, vagina, perineum
86
What are epidurals used for
Stage 1 through perineal repair
87
Considerations with epidural
Maternal hypotension, N&V, respiratory depression
88
What is it called when woman gets a epidural and she only feels pain on one side or a certain section
Spotty epidural
89
Epidurals administered for
| _______ or _______ or ________
One time l&d.
Patient controlled using Indwelling catheter
Combined Spinal-Epidural Analgesia (CSE)
90
Characteristics of Combined Spinal-Epidural Analgesia (CSE)
Ability to bear down preserved; no loss of pushing reflex; motor power intact; can ambulate
91
What are nursing considerations with a traditional epidural
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
Contraindications of regional epidurals
Risk of bleeding, coagulation disorders/defects, generalized sepsis, local infection @ needle site, back or spinal injury, maternal refusal
93
What should you remember needs to be done before regional anesthetics
Hydrate well prior to procedure. (500-2000cc)
| Helps prevent hypotension
94
With general anesthetics what is mother at risk for
Hypotension, urinary retention, N&V, occasional HA or backache
95
Where is spinal block injected into
Subarachnoid space
96
What is advantage of spinal block
Immediate onset of anesthesia, smaller drug amount required
97
What may occur with spinal block
Headache
98
What should you know about pudenal block
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
When is pudenal block done
Just prior to birth inside pudendal nerve
100
What could be going on mother is complaining extra about pain in bottom
Could have hemorrhoids
101
What is anesthesia for laceration or episiotomy repair
Local infiltration
102
Does local infiltration require small or large amounts of agent
Large
103
When is local infiltration administered
Just prior to birth
104
What are side effects of local infiltration
No side effects for mom or newborn
105
What is general anesthesia
Induced unconsciousness, not used a lot, IV or inhalation, used in a ER situation that does not allow for other techniques
106
What are complications of general anesthesia
Fetal depression, failure to establish patent airway in woman, uterine relaxation which makes you watch for bleeding, maternal vomiting
107
When inserting tube for general anesthesia watch _________ during rapid induction of anesthesia
Cricoid pressure
