Pain Management of Postpartum

Question 1

labour pain is unique to every person based on various contributing factors including

Answer 1

physiologic, emotional, social, and cultural factors

Question 2

physical causes of pain during labour include

Answer 2

• cervical stretching
• hypoxia of uterine muscle due to a decrease in perfusion during contractions
• pressure on urethra, bladder, and rectum
• distention of muscles of pelvic floor

Question 3

pain during first stage is associated with

Answer 3

ischemia of uterus during contractions

Question 4

pain in second stage is caused by

Answer 4

stretching of vagina and perineum and compression of pelvic structures

Question 5

non-pharmacological approaches are largely directed at prevention of

Answer 5

suffering

Question 6

pharmacological approaches are directed at eliminating

Answer 6

physical sensation of labour pain

Question 7

non-pharmacological measures may include

Answer 7

• labour support
• hydrotherapy
• hypnosis
• ambulation and position changes
• transcutaneous electrical nerve stimulation (TENS)
• acupuncture and acupressure
• attention focusing and imagery
• therapeutic touch and massage
• breathing techniques
• effleurage

Question 8

gate control theory of pain

Answer 8

proposes that local physical stimulation can interfere with pain stimuli by closing a hypothetical gate in the spinal cord, thus block pain signals from reaching the brain

Question 9

continuous labour support

Answer 9

• emotional support
• comfort measures
• advocacy
• information and advice
• support from partner

Question 10

hydrotherapy helps because

Answer 10

• warmth and buoyancy of being in water help to release muscle tension
• provides soothing of nerves in skin, promoting vasodilation, reversal of sympathetic nervous response, and a reduction in catecholamines

Question 11

hydrotherapy can cause slowing of labour contractions if

Answer 11

pt is not in active labor - 5 cm dilated

Question 12

changing position frequently at least every _____ minutes helps to relieve pain

Answer 12

30 minutes

Question 13

position changes may help to speed labour by adding benefits of

Answer 13

gravity and changing the shape of the pelvis

Question 14

what position should be avoid during labour

Answer 14

supine b/c it can cause compression of the vena cava and decreased blood return to the heart resulting in a profound hypotensive episode

Question 15

epidural analgesia

Answer 15

injection of a local anesthetic agent and an opioid analgesic agent into the lumbar epidural space

Question 16

epidural may slightly decrease _______ stage of labour and may increase the rate on _________

Answer 16

second stage of labour and may increase the rate on instrument-assisted vaginal deliveries as well as oxytocin administration

Question 17

epidural is typically entered through the _________________ vertebrae

Answer 17

third and fourth lumbar vertebrae

Question 18

epidurals are contraindicated for people with a previous history of

Answer 18

• spinal surgery or spinal abnormalities
• coagulation defects
• cardiac disease
• infections
• untreated hypovolemia
• may be contraindicated for pts receiving anticoagulation therapy

Question 19

complications of epidurals include

Answer 19

• n+v
• hypotension
• fever
• pruritus
• intravascular injection
• fever
• allergic reaction
• respiratory depression

Question 20

epidural effects on fetus during labour may include

Answer 20

fetal distress secondary to mom experiencing hypotension

Question 21

to minimize hypotension after epidural has been places patient should avoid

Answer 21

supine position

Question 22

pudendal nerve block

Answer 22

injection of local anesthetic into pudendal nerves near ischial spine

Question 23

pudendal nerve block provides pain relief to

Answer 23

lower vagina, vulva, and perineum

Question 24

pudendal nerve block is used in the _______ stage of labour or for

Answer 24

second stage of labour or for an episiotomy, or an operative vaginal birth with putlet forceps or vacuum extractor

Question 25

pudendal nerve block must be administered ____ minutes before it would be needed to ensure its full effect

Answer 25

15 minutes

Question 26

complication are uncommon with pudendal nerve block but there is a risk of

Answer 26

transient fetal bradycardia from this procedure

Question 27

general reserved for emergency ___________ births

Answer 27

cesarian