Week 4 (Pain Management) Lecture

Question 1

Discuss the fear, tension and pain cycle. What causes it? What is a nursing consideration?

Answer 1

Excess anxiety -> tense -> pain & discomfort incr & birthing process slows

Previous experience may impact this experience

Explain equipment, interventions and show them around

Question 2

Critical thinking:

Brim is G3T1P0A1L1 at 41 weeks. She presents to L&D with noticeable anxiety and indicates that her last labour was “unbearable”. She describes her previous delivery as “traumatic” as forceps were used due to concerns with the fetal heart rate.

1) What effects of anxiety might impact Brim’s progress of labour?
2) What priorities for nursing care would be appropriate?

Answer 2

1) Anxiety about previous labour experience

2) Listen to experiences & acknowledge them; Ask what she wants; Post-traumatic counselling after birth

Question 3

What is the purpose of pain during labour and birth?

Answer 3

Pain is a biological, psychological and cultural experience.

Pain includes sensory, cognitive, and affective components.

Labour pain is situation specific, limited duration and is part of the normal physiological process.

Pain and discomfort experienced during labour have three origins: visceral, somatic, and referred.

Question 4

Pain and discomfort experienced during labour have 3 origins, what are they?

Answer 4

1) Visceral
2) Somatic
3) Referred

Question 5

What is the PAIN acronym?

Answer 5

P- Purposeful
A- Anticipated
I- Intermittent
N- Normal

Question 6

What is visceral pain? Where is it located? List some interventions.

Answer 6

Distension of the lower uterine segment, contraction, stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures (e.g., fallopian tubes, ovaries, ligaments) and nerves, and uterine ischemia.

Located over lower portion of abdomen.

Counter pressure & hip squeeze may help.

Question 7

What is referred pain? Where is it located?

Answer 7

It originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs.

Question 8

What is somatic pain? Where is it located? When is this pain felt?

Answer 8

Somatic pain: intense, sharp, burning, and well localized

• Distension of and traction on the peritoneum and uterocervical supports during contractions
• Pressure against the bladder and rectum
• Stretching and distension of perineal tissues and the pelvic floor to allow passage of the fetus
• Lacerations of soft tissue (e.g., cervix, vagina, perineum)

Occurs during the 2nd stage of labour (active) and is known as the “ring of fire”
- Lacerations (tears to cervix & perineum may occur here)

Question 9

Discuss the different perceptions of pain. What is it influenced by?

Answer 9

Perception of pain and behavioural response to pain is influenced by gender, social, ethnic and cultural differences.

• Meaning of pain and verbal and non-verbal expression of pain are learned from interactions.
• Cultural influences may influence acceptable and unacceptable behaviours when in pain.

Question 10

True or false: inquiring about beliefs, values, expectations, and practices of various cultures will help the nurse assess the woman’s pain experience more accurately.

Answer 10

True

Question 11

What are the factors influencing pain responses? (7)

Answer 11

1) Physiological factors
2) Culture
3) Anxiety and fear
4) Previous experience
5) Gate-control theory of pain
6) Supportive care
7) Environment

Question 12

How may a woman react to labour? (7)

Answer 12

1) Incr HR, BP & RR
2) Sweaty
3) Hyperventilation?
4) May cry/groan
5) Rigidity
6) Exhaustion
7) Lots of pain

Question 13

What are some changes a nurse can do to change the labouring woman’s environment? (10)

Answer 13

1) Dim lights
2) Decr sounds
3) Music
4) Good temp
5) Whisper voice
6) Period of silence
7) Calm/unrushed
8) Be w/ them
9) Allow movement (birthing ball)
10) Tub

Question 14

If continuous supportive care begins early on, what can that do? How can the nurse help?

Answer 14

1) Relieves pain
2) Improves outcomes
3) Decreases interventions
- Decr risk of c-section
4) Decreases complications
5) Enhances overall maternal satisfaction

• Family-centered approach -> assist the partner and support people to cope with stress and anxiety.
• Encourage support individuals to drink fluids, eat, and rest when possible.
• Offer other stimulant to distract her from pain
• Calm/quiet environment

Question 15

What is a woman’s satisfaction with childbirth experience influence by?

Answer 15

1) Personal expectations of childbirth were met
2) Quality of support and interactions received
3) Degree in which client was able to stay in control of the labour
4) Participation in shared decision making

Question 16

What are some signs that show that a woman is doing well in labour?

Answer 16

Relaxation: when contractions are over

Rhythm: rhythmic motion during contractions (moving, moaning, breathing, rocking, swaying, etc)
- Thought process can also be rhythmic

Ritual: repetition of rhythmic activity after contraction
- Tells us she’s in a zone and doing this instinctually)

Question 17

What is pain vs. suffering?

Answer 17

Pain is an unpleasant physical sensation

Suffering involves being overwhelmed

Suffering is an emotional reaction to the physical sensation that may lead to trauma.

Pt can be in pain but not suffering, or vice versa.