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Nursing 240 > TBL: maximizing comfort for the laboring woman > Flashcards

TBL: maximizing comfort for the laboring woman Flashcards

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1
Q

where are pain impulses transmitted from during the first stage of labor?

A

T1 and T2 spinal nerve segment and accessory lower thoracic and upper lumbar sympathetic nerves

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2
Q

what pain is considered visceral pain during the first stage of labor?

A

distention of the lower uterine segment

stretching of cervical tissue as it effaces and dilates

pressure and traction on adjacent structures

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3
Q

where does referred pain from the uterus radiate?

A 
abdominal wall
lumbosacral area of the back 
iliac crests
gluteal area
thighs
lower back
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4
Q

During the first stage of labor, when is the woman usually at a state of discomfort?

A

only during contractions

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5
Q

If the fetus is in a posterior position, when is the mother in pain?

A

in between contractions as well as during

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6
Q

During the second stage of labor, the woman has somatic pain. What is this described as?

A

intense
sharp
burning
well localized

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7
Q

What two factors can increase the amount of pain and discomfort a laboring woman experiences?

A

fear

lack of information

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8
Q

what endogenous opioids are secreted by the pituitary gland and act on the central and peripheral nervous systems to reduce pain?

A

beta-endorphins

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9
Q

what are the 2 most helpful interventions in enhancing comfort?

A
  • caring nursing approach

- a supportive presence

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10
Q

what should the labor/delivery environment include?

A
  • space for movement, ambulation, and equipment such as birthing balls
  • comfortable chairs, tubs, and showers readily available
  • items from home such as pillows, objects for focal point, music, iPad, or DVDs
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11
Q

what is an advantage of non pharmacological methods of pain relief compared to pharmacological methods?

A

non pharmacological methods allow the normal course of labor to progress more efficiently while pharmacological methods tend to interrupt or even slow the labor process

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12
Q

which herbal tea helps women in labor relax?

A

chamomile

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13
Q

which herbal tea reduces nausea?

A

lemon balm

peppermint

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14
Q

which herbal tea enhances energy and reduces fatigue?

A

ginger

ginseng

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15
Q

what is the purpose of breathing techniques in the first stage of labor?

A

promotes relaxation of the abdominal muscles and thereby increase the size of the abdominal cavity

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16
Q

what is the purpose of breathing techniques in the second stage of labor? what may this prevent?

A
  • increases abdominal pressure and thereby assist in expelling the fetus
  • used to relax the pudendal muscles to prevent precipitate expulsion of the fetal head
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17
Q

how can a nurse help a woman in labor with breathing techniques?

A

model breathing techniques

breathe in synchrony with the woman and her partner

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18
Q

what is slow-paced breathing? when is it initiated?

A
  • performed at approximately half the woman’s normal breathing rate
  • when she can no longer walk or talk through contractions
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19
Q

what is modified-paced breathing? when is it initiated?

A
  • shallower and faster
  • should never exceed twice her resting respiratory rate
  • when the contractions increase in frequency and intensity
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20
Q

what is patterned-paced breathing? when is this initiated?

A
  • consists of panting breaths combined with soft blowing breaths at regular intervals
  • during the transition phase of the first stage of labor, when the cervix dilates from 8 cm to 10 cm
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21
Q

what is an undesirable reaction to patterned-paced breathing?

A

hyperventilation

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22
Q

symptoms of respiratory alkalosis? what causes this? tx?

A

lightheadedness
dizziness
tingling of the fingers
circumoral numbness

hyperventilation

breathing into a paper bag or hands

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23
Q

what is cleansing breathing?

A

in through the nose and out through the mouth

used at the beginning and end of each contraction

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24
Q

what is effleurage?

A

light massage or stroking of the abdomen, thigh, or chest in rhythm with breathing during contractions used to distract the woman from contraction pain

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25
Q

what is counterpressure?

A

steady pressure applied by a support person to the sacral area with a firm object or the fist or heal of a hand

helpful for back pain

can be applied to both hips or to the knees

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26
Q

what is therapeutic touch?

A

uses laying on of hands by a specifically trained person to redirect energy fields associated with pain

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27
Q

when is hydrotherapy usually initiated?

A

when the woman is in active labor 5cm dilated

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28
Q

what is contraindicated when using jet hydrotherapy?

A

use of internal electrodes

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29
Q

what is the time limit for jet hydrotherapy?

A

30-60 minutes at a time

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30
Q

what part of the body should stay out of the water at all times?

A

her shoulders should remain out of water to facilitate the dissipation of heat

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31
Q

what can warm water cause? nursing interventions

A
  • dizziness
  • a shower stool should always be available
  • woman should be assisted when getting in and out of the tub
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32
Q

what is an intradermal water block?

A

the injection of small amounts of sterile water by using a fine needle into four locations on the lower back to relieve low back pains

can be repeated

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33
Q

what will be expected within 20-30 mins of intradermal water block?

A

intense stinging

relief of back pain for up to 2 hours

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34
Q

what do lavender, rose, and jasmine oils promote?

A

relaxation

reduce pain

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35
Q

what does rose oil act as?

A

an antidepressant and uterine tonic

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36
Q

what does jasmine oil strengthen?

A

strengthens contractions and decreases feelings of panic in addition to reducing pain

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37
Q

what do bergamot or rosemary relieve?

A

relieves exhaustion

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38
Q

what should you always watch out for with essential oils and herbs?

A

allergic reaction

39
Q

what is hypnosis?

A

a form of deep relaxation, similar to day dreaming or meditation

women are in a state of focused concentration and the subconscious min can be more easily accessed

40
Q

what are the possible side effects of unsuccessful hypnosis?

A

mild dizziness
nausea
headache

41
Q

what is the purpose of a sedative?

A

given to lessen the intensity of the contraction, decrease anxiety, or promote sleep

42
Q

which barbiturate can cause an undesirable effect? what is that undesirable effect? how long before birth should this drug be avoided?

A

secobarbital sodium (Seconal)

respiratory and vasomotor depression for mother and baby

avoided 12-24 hours before birth

43
Q

which antiemetic is found to work best with analgesics?

A

Metoclopramide (Reglan)

44
Q

what is the major disadvantage to diazepam?

A

it disrupts thermoregulation in newborns making them less able to maintain body temperature

45
Q

what is the antidote for benzodiazepines-induces respiratory depression and sedation?

A

Flumazenil (Romazicon)

46
Q

where is a spinal anesthesia block injected? where is the anesthesia affective for a vaginal birth? where is it affective for a c-section birth?

A

injected through the third, fourth, or fifth lumbar interspace into the subarachnoid space

vaginal: hips (T10)- the feet
c-section: nipple (T6)-the feet

47
Q

what is the position of the woman during spinal anesthesia injections?

A

the woman sits or lies on her side (modified Sims position) with back curved to widen the intervertebral space

48
Q

how does the nurse support the woman during spinal anesthesia injections?

A

encourages her to use breathing techniques

relaxation techniques

reminds her to sit still during the placement of the spinal needle

49
Q

when is the anesthetic inserted for a spinal anesthesia?

A

between contractions

50
Q

how may the woman be positioned after the injection of spinal anesthesia for vaginal birth? c-section birth?

A

vaginal birth: upright to allow the heavier anesthetic solution to flow downward

c-section birth: supine with head and shoulders slightly elevated

51
Q

how does the nurse help prevent supine hypotensive syndrome in a patient who just received a spinal anesthesia for a c-section birth?

A

displace the uterus laterally by tilting the operating table or placing a wedge under one of her hips

52
Q

how long does it take for a spinal anesthesia block to take full effect? how long will this last?

A

5-10 minutes
can creep upwards for 20 minutes or longer
lasts 1-3 hours

53
Q

when would you not give someone a spinal anesthesia?

A

if the woman has a tattoo at the site where the needle would be inserted

the risk of transmission of pathogens is too high

54
Q

what side effects may occur with a spinal anesthesia?

A

hypotension
impaired placental perfusion
ineffective breathing pattern

55
Q

how often would you assess vital signs before the administration of a spinal anesthetic? after?

A

every 20-30 minutes

every 5-10 minutes

56
Q

what may be given 15-30 minutes before induction of a spinal anesthetic to decrease the potential of hypotension? what may this NOT contain because it can cause neonatal hypoglycemia?

A

bolus of IV fluid

dextrose

57
Q

what vital signs indicate an emergency situation of maternal hypotension and decreased placental perfusion?

A

maternal hypotension: drop in systolic BP to 100 mmHg or less (20% below baseline BP)

fetal distress: bradycardia, minimal or absent variability, or late decelerations

58
Q

interventions for maternal hypotension with decreased placental perfusion?

A
  • *turn woman to lateral position or place pillow or wedge under hip to displace uterus
  • maintain IV infusion at rate specified, or increase per hospital
  • administer O2 with nonrebreather mask at 10-12 L/min
  • elevate the woman’s legs
  • notify HCP
  • administer IV vasopressor (ephedrine) if previous measures are ineffective
  • remain with woman, continue to monitor vitals every 5 minutes until condition is stable or per HCP order
59
Q

what is a postdural puncture headache (PDPH) aka spinal headache?

A

leakage of CSF from the site of the puncture of the dura mater

occurs when the dura is accidentally punctures during the spinal anesthetic administration

60
Q

when do the symptoms of a PDPH begin to show? what are these symptoms? what may relieve these?

A

begins within 2 days of the puncture and may persist for days or weeks

headache, tinnitus, blurred vision, photophobia

sitting in an upright position may relieve these symptoms

61
Q

treatment for PDPH?

A

oral analgesics
methylxanthines (caffeine or theophylline)
autologous blood patch

62
Q

what is an epidural?

A

anesthetic or opioid analgesics injected into the fourth or fifth lumbar vertebrae into the epidural space

63
Q

which is the most effect pharmacologic pain relief method for labor?

A

epidural

64
Q

where is block required by an epidural for a vaginal birth? c-section birth?

A

vaginal: T10-S5

c-section: T8-S1

65
Q

what does the epidural relieve? what does it not relieve?

A

relieves pain caused by uterine contractions

does not relieve the pressure sensations that occur as the fetus descends in the pelvis

66
Q

what needle is used for an epidural

A

large bore needle

67
Q

before injecting a woman with a large amount of medication during an epidural what is done?

A

a small amount of medication is injected to be sure the catheter has not been accidentally placed in the subarachnoid space or in a blood vessel

68
Q

what condition may make an epidural injection difficult?

A

obesity

69
Q

does general anesthesia or an epidural present less risk for an obese woman?

A

epidural

70
Q

after the epidural has been administered, how should a woman be positioned?

A

on her side so that the uterus doesn’t compress the ascending vena cava and descending aorta

alternate side to side every hour

71
Q

what is an intermittent block? how common is this?

A

repeated injections of anesthetic solutions

least common

72
Q

advantages of an epidural block?

A
  • woman remains alert and is more comfortable and able to participate
  • good relaxation is achieved
  • airway reflexes remain intact
  • only partial motor paralysis develops
  • gastric emptying is not delayed
  • blood loss is not excessive
73
Q

disadvantages of an epidural?

A
  • woman’s ability to move freely and to maintain control of her labor is limited
  • CNS effects may occur if solution containing a local anesthetic agent is injected into a blood vessel
  • respiratory arrest may occur if dose is too high
  • higher rate of fever especially if labor lasts longer than 12 hours
74
Q

side effects of epidural and spinal anesthesia?

A 
hypotension
fever
urinary retention
local anesthetic toxicity
itching
limited movement
longer second stage of labor
increased use of oxytocin
increased likelihood of forceps or vacuum assisted birth
75
Q

s/s of local anesthetic toxicity?

A 
lightheadedness
dizziness
tinnitus
metallic taste
numbness of the tongue and mouth
bizarre behavior
slurred speech
convulsions
loss of consciousness
76
Q

which opioid is major cause of pruritus?

A

fentanyl

77
Q

what is the combined spinal-epidural analgesia technique referred to as?

A

walking epidural

78
Q

side effects of a walking epidural? what may be given to manage these side effects without decreasing the level of analgesia achieved?

A

pruritus
urinary retention
respiratory depression
nausea

naloxone

79
Q

which opioids are commonly used alone to produce a rapid onset of pain relief without causing maternal hypotension or affecting vital signs? who is this most likely given to?

A

fentanyl
sufentanil
preservative-free morphine

nulliparous women or women with a hx of long labors

80
Q

what are the epidural block effects on the newborn?

A

little or no lasting effect on the physiologic status of the newborn

81
Q

what is nitrous oxide?

A

nitrous oxide mixed with oxygen and inhaled via face mask in a low concentration to provide analgesia during the first and second stages of labor

82
Q

side effects of nitrous oxide?

A

nausea
vomiting
dizziness
drowsiness

83
Q

how often is general anesthesia used for a uncomplicated vaginal birth? c-section birth?

A

rarely

10% of c-section births in the US

84
Q

what is priority for recovery room care after general anesthesia to prevent postpartum hemorrhage?

A

maintain an open airway

85
Q

what part does the nurse play in the informed consent?

A

clarifying and describing procedures

acting as a the woman’s advocate and asking the HCP for further explanations

86
Q

two nursing diagnoses for nonpharmcological pain management?

A

anxiety r/t lack of confidence in ability to cope effectively with pain during labor

readiness for enhanced childbearing process r/t desire for healthy outcome of labor and birth

87
Q

what should the woman be reminded to do before the analgesic or anesthetic administration?

A

empty her bladder

88
Q

what should the nurse tell the woman it will feel like when the catheter is threaded into the epidural space?

A

she may have a momentary twinge down her leg, hip, or back

not a sign of injury

89
Q

is IM a perferred route for women in labor?

A

No

90
Q

nursing interventions prior to an epidural or spinal anesthesia?

A
  • assist HCP to explain the procedure, answer any questions, and obtain informed consent
  • assess maternal vital signs, level of hydration, labor progress, and FHR/pattern
  • start and IV line and infuse and bolus of fluid if ordered
  • obtain lab results
  • assess the woman’s level of pain using a pain scale
  • assist the woman to void
91
Q

nursing interventions during initiation of an epidural or spinal anesthesia?

A
  • assist the woman with assuming and maintaining proper positioning
  • verbally guide the woman through the procedure, explaining sounds and sensations as she experiences them
  • assist the anesthesia care provider with documentation of vital signs, time, and amount of medications given
  • monitor maternal vital signs and FHR
  • have oxygen and suction available
  • monitor for signs of local anesthetic toxicity as the test dose is adminstered
92
Q

nursing interventions while the block is in place?

A
  • continue to monitor vitals
  • continue to assess pain scale with vitals
  • monitor for bladder distention
  • insert a urinary catheter if necessary
  • encourage and assist woman to change positions every hour
  • promote safety
  • keep epidural catheter insertion site clean and dry
  • continue to monitor for anesthetic side effects
93
Q

nursing interventions while the block is wearing off after birth?

A
  • assess regularly for return of sensory and motor function
  • continure to monitor vital signs
  • monitor for bladder distention
  • promote safety
  • keep the insertion site clean
  • continue to monitor for anesthetic side effects

Nursing 240 (2 decks)

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