Pain managment for childbirth chapter 18

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  1. Childbith pain is unique because it is normal and self-limiting can be prepared for and ends with a baby's birth
  2. Excess or poorly relieved pain can be harmful to the mother and fetus
  3. Pain is complex physical and psychologic experience.  It is subjective and personal
  4. Four sources of pain cervical dilation uterine ischemia pressure and pullin on pelvic structurs and vaginal and perineal distention are present in most labors.  other physical and psychologic factors may alter the pain felt from these sources
  5. Relaxation enhances other pain management techniques
  6. Any drug that teh expectant mother takes wheter therapeutic herbal/botanical or abused may affect the fetus directly or indirectly
  7. Cutaneous and mental stimulation techniques reduce pain perception.  Techniques shoul be varied to prevent habituation
  8. The purpose of breathing techniques is to increase relaxation
  9. physiologic alterations of pregnancy may affect a womens response to medications
  10. Major advantages of regional pain management  methods are tehat the woman can participte in the birth and that she retains her protective airway reflexes
  11. The nurse should observe for and take actions to prevent maternal hypotension with an eqidural or SAB
  12. THe main nursing obsrevations for the woman who receives eqidural or intrathecal opioids are for nausea and vomiting pruritus and delayed resp depression
  13. THe nurse should observe for respiratory depression primarily in the newborn when the mother has received opioid analgesics during labor
  14. Regurgitation with aspiration of acidic gastric contents is the greatest risk for a woman who receives general anesthesia
  15. Blocking effect of a drug
  16. loss of sensation with or without loss of consciousness
  17. Maximum pain one is willing to endure
    Pain tolerance
  18. Relief of pain without loss of consciousness
  19. Causing a physiologic effect
  20. natural substance similar to morphine
  21. Explain how childbirth pain differs from other pain?
    Childbirth pain is normal process 

    the woman has several months to prepare

    labor pain has a foreseeable end

    labor pain is not constant

    labor pain ends with the birth
  22. how can excessive pain reduce fetal oxygenation
    • Excessice pain can result in fear and anxity which stimulates teh sympathetic nervous system to release substances and simultaneousl cause vasoconstriction and pooling of maternal blood in her vascular system plus a highr uterine muscle tone with reduction of effective contactions.
    • The net effect is that blood flow to and from teh placenta falls and labor contractions are less effective thus prolonging labor
  23. How is labor accected when teh fetus is in occiput posterior (OP) position
    • The fetal occiput is pushed against the womans sacral promontor with each contraction causing intense back pain 
    • in addition the fetus must usually rotate into the occiput anterior position to be born so labor is often longer
  24. List four categories of non-pharmacologic techniques that can be used during labor

    cutaneous stimulations 

    mental stimulations

  25. Give an example of both direct and indirect effects of maternal drugs on the fetus
    Direct- fetal heart rate FHR  has a decreased varibility

    Indirect - maternal hypotension will decrease fetal blood flow.
  26. What is the purpose of giving a test dose before doing an epidural block? What would be signs of problems after the test dose and what causes these signs
    The test dose is given to identify inadvertent subarachnoid or intravascular injection of the drug 

    Evidence of these problems includes rapid and intense motor and sensory block (subarachnoid injection) or numbness of the tongue and lips lightheadedness dizziness and tinniuts (itravascular injection)
  27. What causes the adverse reactions to epidural block analgesia/anesthesia? What may be done to prevent or correct: HEADACHE
    Inadvertent dural puncture may allow spinal flow to leak, causing intense headache that is worse when sitting or standing.  A blood patch may give prompt relief.  Lying flat and adding hydration helps helps rebuild the spinal fluid.
  28. What causes the adverse reactions to epidural block analgesia/anesthesia? What may be done to prevent or correct: HYPOTENSION
    Prehydration with warmed intravenous solution (500 ml to 1000 ml or more) and avoiding aortocaval compression reduce hypotensive effects.
  29. What causes the adverse reactions to epidural block analgesia/anesthesia? What may be done to prevent or correct: BLADDER DISTENSION
    Regularly assess the bladder and have teh woman void at least every 2 hours
  30. What causes the adverse reactions to epidural block analgesia/anesthesia? What may be done to prevent or correct: PROLONGED 2ND STAGE LABOR
    Coach woman to push with contractions if she can not feel them.  Forceps or vacuum extraction may be neccessary
  31. In which regional anesthesia method is it desirable to obtain cerebrospinal fluid (CSF)? Why?
    Varibility reflects normal function of the autonomic nervous system which helps the fetus adapt to teh stress of labor.
  32. List methods to relieve pain of a postspinal headache.
    Bedrest with oral or intravenous hydration

    blood patch
  33. Under what two circustances should butorphanol (stadol) or nalbuphine (Nubain) not be given to a woman in labor?
    These drugs have combined opioid agonist antagonist effects and should not be given to a woman who has had a recent dose of a pure opioid agonist (many reverse effectiveness of first drug) or to a woman who is addicted to opiates such as heroin (may precipitate acute withdrawal)
  34. Firm sacral pressure is likely to be most helpful in which situation?
    Fetal occiput posterior position
  35. A woman receives meperidine (demerol) during labor.  Because this analgesic is being used the nurse should have on hand?
    Narcan (naloxone)
  36. When stocking a cart for epidural analgesia teh most important nursing action is to?
    Verify that no epidural drugs have preservatives
  37. The appropriate nursing action for a woman who has a postspinal headache is to?
    encourage intake of fluids that she enjoys
  38. A woman having her first baby is trying to use breathing techniques during labor but she has difficulty concentrating.  She is 3cm dilated 80% effaced and the station is 0.  WHat nursing measure can best help her?
    help her find a specific point in the room on which to focus
  39. A woman must have general anesthesia for planned cesarean birth because of previous back surgery.  THe nurse should therefore expect to administer:
    Ranitidine (zantac)
  40. A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions that are every 3-5 min which are becoming stronger. Vaginal exam reveals that teh client cervix is 3 cm dilated 80 % effaced and -1 station.  The client states taht she wants pain medication at this time which of the following interventions should the nurse suggest to the client at this time? (all that apply)
    Patterned breathing techniques

    Butorphanol (stadol) 2 mg IV as prescribed

    application of heat or cold

    distraction of a focal point
  41. A nurse is caring for a client who is in active labor.  the client reports lower back pain.  The nurse suspects that this pain is persistent occiput posterior presentation.  WHich of the following nonpharmacological nursing interventions should best alleviate this pain.
    Sacral counterpressure
  42. A nurse anesthetist is explaining an eqidural procedure to a client who agrees that this is the best way to help suppress her pain. What is the role of the nurse before during and after administration of and epidural (all that apply)
    Administer a bolus of IV fluids prior to eqidural insertion

    Have oxygen and suction ready in the event of repiratory depression

    Palpate the clients bladder for distention and insert indwelling foley catheter if necessary.
  43. A nurse is caring for a client who is primipara and in active labor.  The client received meperidine  (demerol) 50 mg IV for pain 30 min prior to precipitous delivery.  Which of the following medications should the nurse be prepared to administer.
    Naloxone (Narcan) to the neonate
  44. A nurse is caring for a client who is in labor.  Which of the following should the nurse assess for following placement of an epidural?
    Hypotension in the mother.
  45. a client in laborand delivery unit is in the second stage of labor. Her labor has been progressing well without complications ans she is expected to deliver vaginally in 20 min.  The primary care provider is preparing to administer lidocaine (xylocaine) for pain relief and preform an episiotomy.  The nurse knows that this type of regional anesthetic block that will likely be used with which of the following?
    Prudendal block
  46. A  nurse caring for a client in labor.  The client experienes hypotension and fetal bradycardia.  Which of the following nursing actions should the nurse implement (all that apply)
    Administer an ephedrine IV bolus

    Place the client in side lying positon 

    Increase IV fluids

    Administer O2 via face mask
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Pain managment for childbirth chapter 18
2013-03-26 01:17:07
Pain managment childbirth chapter 18 SPC nursing

Pain managment for childbirth chapter 18 SPC nursing PEDI rotation
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