Quiz #3 - IP Pain Management During Childbirth

Question 1

Why is childbirth a unique process?

Answer 1

It’s part of a normal process, the woman has months to prepare, it has a foreseeable end

Question 2

What are some physiologic effects of excessive pain?

Answer 2

Increase in metabolic rate/oxygen demand, increase in production of catecholamines, cortisol, glucagon, less oxygen exchange for fetus

Question 3

What are some psychological effects of excessive pain?

Answer 3

Difficulty interacting with infant, unpleasant memories, partner may feel inadequate

Question 4

What are some sources of pain in childbirth?

Answer 4

Tissue ischemia, cervical dilation, pressure on pelvic structure, distention of vagina

Question 5

What are some physical things that can change a woman’s perception of her pain?

Answer 5

Intensity of labor, fetal position and size, characteristics of the pelvis, fatigue, intervention of caregivers

Question 6

What are some psychosocial things that can change a woman’s perception of her pain?

Answer 6

Culture, anxiety/fear, past bad experience, preparation of birth, support systems

Question 7

What are some nonpharmacologic methods of pain management?

Answer 7

Relax! Hypnotherapy, distraction, breathing, classes, thermal therapy, water therapy, birthing/peanut ball

Question 8

Why can pharmacologic pain management be dangerous?

Answer 8

Changes the mom’s heart & breathing, GI change, nervous system change - can affect course of labor!

Question 9

What are types of regional pain management?

Answer 9

Anesthesia, pudendal block, epidural block, local infiltration anesthesia, combined spinal-epidural, subarachnoid block

Question 10

What are advantages of regional pain management?

Answer 10

The mom can still participate in the birthing experience! Good pain control. Can still interact. Retains airway reflex.

Question 11

Why would regional pain management be contraindicated?

Answer 11

With thrombocytopenia, with history of back surgery, imminent delivery (takes awhile to work)

Question 12

What adverse effects can epidural bring?

Answer 12

Hypotension in mom, distortion of bladder, the epidural catheter moves, fever

Question 13

What adverse effects can epidural opioids bring?

Answer 13

N/V, itching

Question 14

How to prepare for epidural?

Answer 14

1. Obtain the order
2. Notify anesthesia
3. Explain procedure to patient
4. Ambulate to bathroom to empty bladder
5. Bolus IV 500-1000 cc RL 6. Position them sitting or lying

Question 15

What should be monitored after epidural?

Answer 15

Vital signs, level of mobility, LOC, perception of pain & pain relief, fetal status

Question 16

When should infusion of epidural be stopped?

Answer 16

To replace empty infusion syringes/bags, if there is safety concern, or if birth is finished

Question 17

Nitrous Oxide

Answer 17

Administration of 50% nitrous oxide is documented by the nurse on the MAR as “prn self-administered nitrous”

Question 18

What are contraindications of nitrous oxide?

Answer 18

<35 week gestation, cannot hold face mask, drug/alcohol use, impaired LOC, impaired O2 sat, category III or II FHR, IV opioids within 2 hours, obesity

Question 19

When is general anesthesia given?

Answer 19

During STAT c-sections

Question 20

What are some adverse effects of general anesthesia?

Answer 20

Maternal aspiration, respiratory depression