Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

TBL: maximizing comfort for the laboring woman Flashcards

You may prefer our related Brainscape-certified flashcards:
Family Nurse Practitioner (FNP) flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Maternity flashcards Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Adult Health flashcards Nursing Safety & Infection flashcards Nursing Mental Health flashcards
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

only during contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

in between contractions as well as during

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

intense
sharp
burning
well localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

fear

lack of information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the 2 most helpful interventions in enhancing comfort?

A
  • caring nursing approach

- a supportive presence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which herbal tea helps women in labor relax?

A

chamomile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which herbal tea reduces nausea?

A

lemon balm

peppermint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which herbal tea enhances energy and reduces fatigue?

A

ginger

ginseng

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is an undesirable reaction to patterned-paced breathing?

A

hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is therapeutic touch?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when is hydrotherapy usually initiated?

A

when the woman is in active labor 5cm dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is contraindicated when using jet hydrotherapy?

A

use of internal electrodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the time limit for jet hydrotherapy?

A

30-60 minutes at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what do lavender, rose, and jasmine oils promote?

A

relaxation

reduce pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what does rose oil act as?

A

an antidepressant and uterine tonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what does jasmine oil strengthen?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what do bergamot or rosemary relieve?

A

relieves exhaustion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions