T3: Maximizing Comfort for the Laboring Woman

Question 1

gate-control theory

Answer 1

the spinal cord contains a neurological “gate” that blocks pain signals or allows them to pass on to the brain

Question 1

assessment of pain

Answer 1

• Believe patients self-report
• Use the pain scale
• Where is the pain?
• What will help?

Question 2

nonpharmacologic management

Answer 2

music, meditation, massage, warm bath, hypnosis, patterned breathing, controlled relaxation techniques, biofeedback

Question 3

slow paced breathing

Answer 3

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.

Question 4

Massage and touch

Answer 4

effleurage, counterpressure, therapeutic touch, healing touch

Question 5

Effleurage

Answer 5

Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner.

Question 6

Counter pressure

Answer 6

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

Question 7

sedatives for labor pain

Answer 7

given in early labor for rest (not pain relief)

seconal/nembutal - monitor for resp and vasomotor depression of mom+baby
- promethazine, hydroxzine, diazepam, lorazepam

Question 8

what must a nurse do in order to give an IV pain medication (sedative)

Answer 8

a sterile vaginal exam

Question 9

when can a sedative not be given

Answer 9

if the patient is 8cm or >

Question 10

how to administer sedatives

Answer 10

slowly

Question 11

antidote to sedatives

Answer 11

narcan

Question 12

Pudendal block

Answer 12

anesthetic administered to block sensation around the lower vagina and perineum

Question 13

spinal block is used for

Answer 13

scheduled c-section

Question 14

epidural block

Answer 14

regional anesthesia that numbs the woman’s body from the waist down (injected into epidural space)

Question 15

what is needed before an epidural

Answer 15

-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

Question 16

what labs cnnot be low to give an epidural

Answer 16

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

Question 17

if the bladder is full..

Answer 17

the baby will have a hard time descending

Question 18

hypotension from an epidural can cause

Answer 18

late decelerations

Question 19

side effects of epidural

Answer 19

• 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

Question 20

complications of epidural

Answer 20

• Hypotension leading to fetal bradycardia or late decelerations
• Intravascular injection
• “Total Spinal”
• Spinal headache
• Infection
• Impotent block or “spotty” block
• Epidural hematoma