T3: Maximizing Comfort for the Laboring Woman Flashcards
gate-control theory
the spinal cord contains a neurological “gate” that blocks pain signals or allows them to pass on to the brain
assessment of pain
- Believe patients self-report
- Use the pain scale
- Where is the pain?
- What will help?
nonpharmacologic management
music, meditation, massage, warm bath, hypnosis, patterned breathing, controlled relaxation techniques, biofeedback
slow paced breathing
Paced breathing technique during which the woman breathes at approximately half her normal rate (6-8 breaths per minute). It is usually the first technique used in early labor when the woman can no longer talk or walk her way through a contraction.
Massage and touch
effleurage, counterpressure, therapeutic touch, healing touch
Effleurage
Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner.
Counter pressure
steady pressure applied by a support person to the sacral area with a firm object, or fist or heel of hand. Helps to cope with lower back pain
sedatives for labor pain
given in early labor for rest (not pain relief)
seconal/nembutal - monitor for resp and vasomotor depression of mom+baby
- promethazine, hydroxzine, diazepam, lorazepam
what must a nurse do in order to give an IV pain medication (sedative)
a sterile vaginal exam
when can a sedative not be given
if the patient is 8cm or >
how to administer sedatives
slowly
antidote to sedatives
narcan
Pudendal block
anesthetic administered to block sensation around the lower vagina and perineum
spinal block is used for
scheduled c-section
epidural block
regional anesthesia that numbs the woman’s body from the waist down (injected into epidural space)
what is needed before an epidural
-basline maternal VS and FHR
-have patient VOID
-HYDRATE with 500-1000mL LR or NS
-O2 ready
-Position patient either side lying or sitting on edge of bed
-VS after procedure per protocol
what labs cnnot be low to give an epidural
hemoglobin and platelets: if either of these are LOW they will not do an epidural because of the risk of bleeding at the epidural site
if the bladder is full..
the baby will have a hard time descending
hypotension from an epidural can cause
late decelerations
side effects of epidural
- Bladder distention
- Elevated temperature
- Short or long term backache
- Disruption of labor
o Increased length of first and second stage of labor
o Increased use of oxytocin
o Increased use of instrumentation
o Increased incidence of Cesarean section
complications of epidural
- Hypotension leading to fetal bradycardia or late decelerations
- Intravascular injection
- “Total Spinal”
- Spinal headache
- Infection
- Impotent block or “spotty” block
- Epidural hematoma
