T2-Management of Discomfort during Labor and Birth Flashcards
What do breathing techniques in the first stage of labor promote? What does this do?
Promotes relaxation of the abdominal muscles and that increases the size of the abdominal cavity…this lessons discomforts and does not interfere with fetal descent
What are breathing techniques in the second stage of labor used? What does this do?
Used to increase abdominal pressure and assist in bearing down–> this assists with expelling of fetus; can also be used to relax the pudendal muscles
What do all pattens of breathing begin and end with?
Deep, relaxing, cleansing breath to “greet the contraction” and end it by “gently blowing it away”
How many breaths per min are there with slow paced breathing?
6-8 breaths per min (performed at approx half the normal breathing rate)
When are slow paced breathing techniques initiated?
When woman can no longer walk or talk through the contractions
When do we start to use the modified pace breathing?
Once contractions increase in frequency and intensity
Describe the modified pace breathing.
More complex; shallower and faster than a normal breathing rate but does not exceed twice the womans resting rate
When is the most difficult time to maintain control during contractions?
During the transition phase of the first stage of labor when the cervix dilates from 8cm-10cm
What breathing technique is suggested during the transition phase of labor?
Pattern paced (pant-blow)
What breathing technique can cause hyperventilation?
Pattern paced (pant-blow)
What does hyperventilation lead to?
Respiratory alkalosis
What are signs of resp. alkalosis?
Lightheadedness
Dizziness
Tingling of fingers
Circumoral numbness or blueness
What is the intervention if the woman is hyperventilating and experiencing resp. alkalosis?
Breathe in paper bag or cup hands around mouth and nose and breathe
What are some cutaneous stimulation strategies to enhance relaxation and decrease discomfort during labor?
- Counterpressure
- Effleurage, touch, massage
- Walking, rocking, changing positions
- Heat or cold applications
- TENS, acupressure, water therapy
What is effleurage?
What is counter pressure?
Effleurage: Light stroking of abdomen or back in rhythm with the patient’s breathing during a contraction
Counterpressure: Steady pressure applied to sacral area
What are some sensory stimulation strategies to enhance relaxation and decrease discomfort during labor?
- Aromatherapy
- Breathing techniques
- Music
- Imagery
- Focal points
What are some cognitive strategies to enhance relaxation and decrease discomfort during labor?
- Using childbirth education
- Hypnosis
- Biofeedback
Where does referred pain originate? Radiates to?
Originates in the uterus and radiates to the abdominal wall, lumbar-sacral area of the back, iliac crests, gluteal area, and down the thighs
A breathing pattern that is no more than ____ the normal rate helps reduce the chance of resp. alkalosis
2x
What do barbiturates do?
Relieve anxiety and induce sleep
When can we give barbiturates?
In early labor
When are barbiturates not used and why?
In active labor because of CNS depression in newborn
What do ataractics do?
Reduce anxiety, apprehension, and N&V, but also increases sedation
Ataractic are thought to _____ opioid analgesic medication effects
Potentiate
What may ataractics contribute to?
Maternal hypotension and neonatal depression
What are examples of ataractics?
Promethiazine (phenergan) and hydroxyzine (vistaril)
When do we give meds to the mother and why?
While patient is at the top of a contraction because the mom will get most of the drug and not as much will cross through to the baby due to vasoconstriction
What are examples of pure opioid agonists?
*agonist: Agent that stimulates a receptor to act
- Dilaudid
- Demerol (merperidine)
- Fentanyl (sublimaze)
- Sufenta (sufentanil)
What are some SE of the opiod agnostic?
Decrease gastric emptying and increase NV; may cause inhibition of the bladder
What is demerol onset of action IV vs. IM
IV almost immediate
IM 10-20 min
Opioid agonist: How are fentanyl and sufenta most commonly administered?
Epidural catheter
What is more potent: Sufenta or fentanyl?
Sufenta
it does not cross the placenta as readily so less fetal exposure to the drug
*Onset: 3-5 min, duration ~60 min
What is the antidote to narcotic analgesic?
Narcan
Who is narcan contraindicated for?
Narcotic addicted patients because may precipitate withdrawal symptoms
What are examples of mixed opioid agonist-antagonist analgesics?
- Stadol (butorphanol tartrate)
- Nubain (nalbuphine hydrochloride)
What do mixed opioid agonist-antagonist analgesics provide?
Adequate analgesia without resp. depression in mom or baby
What is used more in labor: mixed opioid agonist antagonist analgesics or narcotic analgesics (pure opioids)?
Mixed opioid agonist antagonist analgesics
Does Narcan reverse effects of Stadol?
No
What is the regional anesthesia procedure?
Epidural block
What are some epidural advantages?
- Stay alert
- Good relaxation achieved
- Only partial motor paralysis occurs
- Airway reflexes intact
- Gastric emptying not delayed
- Blood loss not excessive
What are some disadvantages of epidurals?
- Limited mobility
- May increase the duration of second stage labor
- Sometimes its not effective and another form of analgesia is required
- Urinary retention
- Itching
- High or total anesthesia
Epidural block meds are usually a combo of ____ and ____
“Caine” drug and opioid analgesic
When is the nerve block analgesia (epidural) administered?
When labor is well established–typically woman is dilated around 5-7 cm
Where are meds injected when giving an epirudal?
Into epidural space and can be done by continuous infusion or intermittent injections
Why do we preload with IV fluids before giving an epidural?
Volume expansion to prevent maternal hypotension
*More fluid=more space so baby is not compromised and more fluid means BP of mom remains stable…If she doesnt get enough fluid, her BP can drop and that can cause baby HR to drop
What is the position the mother is in when we give epidural?
Modified sims or upright with back curved and legs dangling from bed
What position do we do after insertion of epidural?
Assit to alternate side lying positions to prevent supine hypotension and it helps distribute med evenly
Prior to epidural you will receive a fluid bolus to maintain ____
BP
What do we assess post epidural?
VS, FHR, and O2 sat
*O2 sat needs to be started as soon as we know mom is getting epidural because if it goes wrong, mom may not be able to feel herself breathe
Post epidural block nursing interventions: Why do we observe for bladder distention?
Mom can’t feel sense to go
What are some complications of an epidural (4)?
- Accidental “high spinal”
- Significant maternal hypotension
- Post dural puncture headache
- Infection
Complications of epidural: We watch for maternal hypotension because that can cause _______ which causes _____.
Maternal hypotension can cause decreased placental perfusion which causes a non-reassuring FHR pattern (newborn endangerment!)
What can high spinals lead to?
Resp. arrest
What are the nursing care steps for someone who has an hypotension episode with epidural block?
- Turn to lateral position or wedge hip
- Increase IV infusion rate
- O2 by face mask 10-12 L/min
- Elevate clients legs (10-20 degrees)
- Alert doc
- Be prepared to administer vasoconstrictor drugs
What is an example of a vasoconstrictor drug?
Ephedrine
What are some interventions for “ineffective uteroplacental perfusion r/t maternal hypotension associated with epidural block meds”
- Turn sides, use wedge
- Increase IV fluids
- O2 by face mask 12L
- Elevate legs
- Call doc
- Meds to elevate BP
Post dural puncture headache may be seen within ____ of puncture but may continue for _____
2 days and may continue for days to weeks
What position intensifies the post dural headache? What position results in relief from it?
Intensifies: Upright
Relief: Lying flat for 30 min or less
What is the treatment for PDP headache?
Epidural blood patch
*womans blood injected into epidural space and the creates a clot that patches the tear or hole; pain relief is almost instantaneous
T/F: Mtn Dew can help with the PDP headache?
True!
Other treatments are: bedrest, lying flat, increased caffeine (some use mtn dew and excedrin migraine which has high caffeine intake)
When is the pudendal block used?
Birth and post delivery repairs; not labor
Pudendal block: No relief from _____; relief from _____
No relief from UC
Relief from perineum distention
Injection of medication into the CSF in spinal canal
Spinal block
What are advantages of spinal block?
Rapid pain relief w/o sedation; useful for urgent c-section births; low incidence of adverse effects
What are disadvantages of spinal block?
- Short duration of action
- Postspinal headache r/t leakage of spinal fluid
- Increased incidence and degree of hypotension
- Urine retention
What is used frequently for episiotomy?
Local infiltration of perineum
Epinephrine added to “caine” drug to prevent excessive bleeding by constricting blood vessels
Does local infiltration of perineum affect pain of UC? Any adverse effects?
No, no
When is general anesthesia used?
If regional anesthesia is contraindicated or if an emergency situation suddenly develops
What are some examples of inhaled anesthetics?
Nitrous oxide
Halothane
Fluothane
What are fetal adverse effects to general anesthesia?
Resp. depression
Hypotonia
Lethargy
