Pain- EXAM 1 Flashcards
First stage of pain during labor
Dilation of cervix= primary source of pain
Stretching of lower uterine segment
Pressure on adjacent structures
Causes of Second stage labor pains
Hypoxia of contracting uterine muscle cells
Distention of vagina and perineum
Pressure on adjacent structures
Third stage of pain during labor
Uterine contractions
Cervical dilation
Nursing considerations before administering medications
Assess for history of any medication reactions or allergies
Provide info about the medication
Document assessment data: Maternal vital signs, FHR, pain level
What are opioid analgesics used for
early labor
Provide analgesic effect
Induce sedation
What are sedatives used for
To promote rest
Considerations following medication admin
Record drug name, dose, route, and site
Record womens blood pressure and pulse
Assess and document data: pain level, effectiveness, adverse effects if any
Safety precautions
What is Regional anesthesia & examples of it
Provides pain relief throughout labor
Instituted once labor is well establish, 4-5 cm dilated
Ex: epidural, Spinal and Combined epidural-spinal
Level of anesthesia for vaginal birth
pelvis down
Level of anesthesia for c-section
under breast down
What to do when prepping a patient for epidural
Confirm availability of obstetrician
Encourage women to void
Assess data: Maternal pain level, BP, respirations and fetal heart rate
Continuous electronic fetal monitoring
Where do you place an epidural & SE
Needle goes into epidural space
Patient lies on sidde
catheter is inserted through intervertebral space between L2 and L3
SE: Pruitius, Nauseated vommiting, urinary retention
Advantages of epidural
Produces good pain relief
Women is fully awake during labor and birth
Allows different blocking for each stage of labor
Dose can be adjusted
Disadvantages of epidural
Hypotension
Loss of bladder sensation
Prolonged labor
Low back pain
Contraindications of epidurals
Patents may refuse
Infection at needle puncture site
Increased intracranial pressure
Allergy to
Hypovolemic shock
Complications of epidural
postpartum low back pain
nerve injury
infection
hematoma
hypotension
respiratory depression
inadequate pain relief
N/V
Urinary retetnion
Pruitus
Nursing interventions during epidural
Assess maternal vital signs until block wears off
Promote maternal side lying position or what’s comfortable
Frequent repositioning
Assess sensorimotor ability every 30 min
Assess bladder distention
Protect lower extremeties from injury
Spinal anesthesia
Injected into smaller needle directly into cerebrospinal fluid that surrounds the spinal cord
Nubms the whole body below and sometimes above the injection site
Common ones used are Lidocaine, Bupivacaine, Tetracaine and Ropivacaine
Lidocaine
Used as spinal anesthesia, Lasts 1-1.5 hours
Monitor BP & HR
Bupivacaine
Spinal anesthesia that can be used
Lasts 90-150 minutes
Tetracaine
Spinal anesthesia used
Long lasting one, 10+ hours
Ropivacaine
Spinal anesthesia used
Long lasting one, 10+ hours
Nursing interventions of spinal anesthesia
Position women supine with left uterine displacement
Monitor maternal blood pressure and pulse
Recovery from spinal
Cautious transfers from birthing bed
Bedrest for 6-12 hours following block
Restoration of bladder control may take 8-12 hours
What is the biggest side affect of pain med
Hypotension
risk is minimized by admin of crystalloid fluid bolus
If occurs, increase IV flow rate, and administer oxygen
Administer ephedrine if indicated
Nonpharmacologic methods
Control pain during labor
natural childbirth, hypnosis, biofeedback, acupuncture,TENS, psychosocial support
Describe cancer pain
Experienced by 55% of patients undergoing anti-cancer treatment and by 66% who have advanced, metastatic or terminal disease
Causes of cancer pain
Direct tumor involvement
Side effects or toxic effects of cancer therapies
Acute pain
well-defined pattern of onset
Exhibits common signs and symptoms
Chronic pain
Lasts more than 6 months
Often results in personality changes, alterations in functional abilities and lifestyle disruptions
Most common medical disroder
Acute lower back pain
Mild pain
Number range and med level
1-3 on pain scale
Nonopiod medication administered for it
NSAID or ASPRIN
Moderate pain
Number scale and meds used
4-6 on pain scale
Weak opioids given
CODINE, TRAMADOL OR LOW DOSE OF MORPHINE
Severe pain
Number range & meds used
7-10 on pain scale
Strong opioids given
MORPHINE, FENTANYL, OXY, HYDROMORPHINE & BUPROMORPHINE
