Pain Management

Question 1

Non pharmacological nursing interventions directed towards pain relief?

Answer 1

Providing information

Encouragement

Back rubs

Clean linens

Suggesting positional changes

Assisting with relaxation and breathing techniques

Question 2

What are some pharmacologic agents that could be used to decrease discomfort and increase relaxation

Answer 2

Systemic analgesics

Regional nerve blocks (epidural)

Local anesthetic blocks

Question 3

What is the goal of systemic analgesia during labor?

Answer 3

Provide maximal pain relief with minimal risk for the woman and fetus

Question 4

What are some considerations before giving systemic analgesia?

Answer 4

Maternal assessment
- Vital sign stable
-No contraindications
- Accepting of risks and benefits

Fetal assessment

Labor assessment

Available routes

Question 5

What are some examples of systemic analgesia for labor?

Answer 5

Sedatives

Narcotic analgesics

Nitrous oxide

Question 6

What are sedatives used for?

Answer 6

Primarily used during early/latent phase of labor to promote relaxation and rest

Question 7

What are some examples of sedatives?

Answer 7

Benzodiazepine (rarely used)

H-1 receptor antagonist:
- promethazine hydrochloride (phenergan)
- diphenhydramine (Benadryl)

Question 8

When are narcotics used?

Answer 8

Often used during stage one/active phase to inhibit the transmission of pain impulses

Question 9

What are some side effects of narcotics?

Answer 9

Respiratory depression, sedation, hypotension.

Can be reversed using the opiate antagonist naloxone (narcan)

Question 10

What are some examples of narcotics?

Answer 10

Fentanyl

Nalbuphine

Morphine

Question 11

Why is nitrous oxide considered a good option for pain relief?

Answer 11

Safe

Effective

Inexpensive

Self administered by patient as needed (patient hold mask tightly to face and inhales deeply to start flow of gas)

Question 12

When is nitrous oxide contraindicated?

Answer 12

If patient has vitamin B 12 deficiency, such as with anemia, alcoholism, or anorexia

Question 13

What is regional anesthesia?

Answer 13

Injection of a medication into an area that will reach nervous tissue and cause a temporary and reversible loss of sensation

Typically, highly effective in reducing pain sensations

Question 14

What are common side effects of regional anesthesia?

Answer 14

Mild:
Vertigo, urinary retention, pruritis

Moderate:
Nausea, vomiting, hypotension

Severe reactions (rare):
Systemic toxicity, bradycardia, respiratory depression, convulsions, cardiac arrest

Question 15

Nursing care for patients about to get an epidural, and after?

Answer 15

Ensure that IV is patent and preload IV bolus as ordered

Place monitors for vital signs and O2 saturation and FHR

Have O2 by face mask available for a patient during/after placement

Help position patient for epidural insertion

After injection, reposition patient to semi reclining with left uterine tilt

Monitor vital signs, be especially aware of FHR changes, or drop in mom‘s BP

Often, a urinary catheter is placed to drain the bladder

Question 16

Adverse effects of spinal anesthesia

Answer 16

Similar to those for epidural:
-Hypotension
-Shivering
- Urinary retention

Also, a high block can occur, which affects respiratory muscles

Spinal headache can result from leakage of spinal fluid

Question 17

What is a combined spinal - epidural most often used?

Answer 17

For patients with a cesarean birth

Question 18

What are risks for general anesthesia?

Answer 18

Fetal respiratory depression

Maternal aspiration

Failure to establish patent airway

Question 19

Precautions for general anesthesia

Answer 19

Typically, laboring women in the US are limited to clear liquid diet

If the woman is at high risk, she may be asked her remain NPO

Antacid administered to neutralize stomach contents in case of aspiration

Left tilt to displace uterus off of vena cava

Patent IV line

Pre-oxygenate for 3 to 5 minutes with 100% O2

Cricoid pressure by assistant during intubation

Question 20

What are some nursing considerations after receiving general anesthesia?

Answer 20

After experiencing general anesthesia, a patient may need extra support when breast-feeding
- Due to decreased level of consciousness
- Due to the effect of anesthetic agents on the baby
- due to pain level

Question 21

What are some considerations for preterm labor in regards to pain management?

Answer 21

Immature fetus has decreased ability to metabolize drugs

Avoid analgesia or limit to smallest possible dose

Avoid general anesthesia if possible

Question 22

What are some considerations for preeclampsia regarding pain management?

Answer 22

A woman with mild preeclampsia may tolerate the analgesia or anesthesia of her choice

Severe preeclamptic patients at higher risk during both regional and general anesthesia (epidural preferred over spinal or general)

Hypotensive and hypertensive side effects can be more acute for this patient

Question 23

Nursing considerations for patients with diabetes regarding pain management

Answer 23

Vulnerable to poor placental blood flow

Hypotension (a common side effect of regional anesthesia) can deplete blood flow to fetus even more

Important to use IV preload and careful positioning with left tilt to decrease chance of hypotension

Question 24

Considerations for cardiac disease regarding pain management

Answer 24

Pregnancy can be risky for a patient with cardiac disease

With mitral stenosis, preferred anesthesia is epidural for a forceps assisted birth

Question 25

Considerations for bleeding complications regarding pain management

Answer 25

Regional blocks contraindicated during active bleeding episodes due to potential for hypotensive episode

Scheduled cesarean with general anesthesia often recommended

Question 26

What is the major adverse effect with an epidural?

Answer 26

Hypotension caused by vasodilation of the peripheral blood vessels and compression of the vena cava if patient is supine

Question 27

How is hypotension prevented with patients with an epidural

Answer 27

Preloading with IV bolus as ordered

Careful repositioning of patient after

Placement with uterus tilted to left