Maternal Newborn - Test 2 Chapter 19

Front 1

Perception of pain
--the meaning of pain and the verbal and nonverbal expressions given to pain are apparently learned from what?

Back 1

interactions within the primary social group

Front 2

Perception of pain

What 2 cultural groups of women believe it shameful and counterproductive to scream or show pain, and therefore avoid outward expressions when they are in pain

Back 2

Asian and Amish

Front 3

Expression of pain

What nervous system activity is stimulated in response to pain?

what does that increase?

Back 3

-sympathetic nervous system

resulting in increase catecholamine levels (Catecholamines cause general physiological changes that prepare the body for physical activity (fight-or-flight response). Some typical effects are increases in heart rate, blood pressure, blood glucose levels, and a general reaction of the sympathetic nervous system.. ex: norepinephrine and epinephrine)

Front 4

Expression of pain

what happens to BP RR and HR?

Back 4

increase

Front 5

Expression of pain
-Respirations

what adverse efffect can occur as a result of the pain intensifing?

Back 5

-hyperventilation, sometimes accompanied by resp. alkalosis, can occur as pain intensifies

Front 6

Expression of pain

-gastric activity (increases or decrease) and ____ are common in the active phase of labor

Back 6

increases

n/v

Front 7

Expression of pain

-what happens to placental perfusion and uterine activity?

Back 7

may decrease and may diminish which can prolong labor and affect fetal well-being

Front 8

-the sensory quality of visceral and somatic pain has been described as

Back 8

prickling, stabbing, burning, bursting, aching, heavy, pulling, throbbing, sharp, shooting, stinging, or cramping

Front 9

-the emotional quality of pain has been described as

Back 9

tiring, exhausting, annoying, sickening, and nauseating

Front 10

Expression of pain

During labor, what do Chinese woman use to calm and cope with pain?

Back 10

-Chinese women often use soft voices and calm demeanors to cope with pain to conserve energy during labor

Front 11

Expression of pain

What do Mayan women use to cope with pain and enhance labor?

Back 11

repeat a mantra and call out to the Lord

Front 12

Factors influencing pain response

-Physiologic factors:
-in relationship to a womans menstrual periods in the past?

Back 12

-history of dysmenorrheal (b/c of higher prostaglandin levels)

-back pain associated with menstruation

Front 13

Factors influencing pain response
-what position results in decreased pain and increased comfort?

-what is an important factor in reducing pain and muscle tension that the mom should be allowed to do?

Back 13

-upright positions

-being able to move freely to find a position of comfort is an important factor in reducing pain and muscle tension

Front 14

Factors influencing pain response

-Physiologic factors:
what do endorphins and opioids do to pain?

-high endorphin levels may do what?

Back 14

-endorphins and endogenous opioids reduce pain

-higher endorphin levels may increase the ability of women in labor to tolerate pain and may reduce
irritability and anxiety

Front 15

Culture and Pain
-Chinese women

what is their reaction to pain?

what must a nurse consider in relationship to how they feel about pain medications?


what may they use for pain relief?

Back 15

may not exhibit reactions to pain although it is acceptable to exhibit pain during birth

-they consider it impolite to accept something when it is first offered so pain interventions must
be offered more than once
-acupuncture may be used for pain relief

Front 16

Expression of pain

-gastric activity (increases or decrease) and ____ are common in the active phase of labor

Back 16

increases

n/v

Front 17

Expression of pain

-what happens to placental perfusion and uterine activity?

Back 17

may decrease and may diminish which can prolong labor and affect fetal well-being

Front 18

-the sensory quality of visceral and somatic pain has been described as

Back 18

prickling, stabbing, burning, bursting, aching, heavy, pulling, throbbing, sharp, shooting, stinging, or cramping

Front 19

-the emotional quality of pain has been described as

Back 19

tiring, exhausting, annoying, sickening, and nauseating

Front 20

Expression of pain

During labor, what do Chinese woman use to calm and cope with pain?

Back 20

-Chinese women often use soft voices and calm demeanors to cope with pain to conserve energy during labor

Front 21

Expression of pain

What do Mayan women use to cope with pain and enhance labor?

Back 21

repeat a mantra and call out to the Lord

Front 22

Factors influencing pain response

-Physiologic factors:
-in relationship to a womans menstrual periods in the past?

Back 22

-history of dysmenorrheal (b/c of higher prostaglandin levels)

-back pain associated with menstruation

Front 23

Factors influencing pain response
-what position results in decreased pain and increased comfort?

-what is an important factor in reducing pain and muscle tension that the mom should be allowed to do?

Back 23

-upright positions

-being able to move freely to find a position of comfort is an important factor in reducing pain and muscle tension

Front 24

Factors influencing pain response

-Physiologic factors:
what do endorphins and opioids do to pain?

-high endorphin levels may do what?

Back 24

-endorphins and endogenous opioids reduce pain

-higher endorphin levels may increase the ability of women in labor to tolerate pain and may reduce
irritability and anxiety

Front 25

Culture and Pain
-Chinese women

what is their reaction to pain?

what must a nurse consider in relationship to how they feel about pain medications?


what may they use for pain relief?

Back 25

may not exhibit reactions to pain although it is acceptable to exhibit pain during birth

-they consider it impolite to accept something when it is first offered so pain interventions must
be offered more than once
-acupuncture may be used for pain relief

Front 26

Culture and Pain

Arab or middle eastern women and their respodn to pain??

what may they prefer for pain relief?

Back 26

may be vocal in response to labor pain,

they may prefer medication for pain relief

Front 27

Culture and Pain

-Japanese women and pain?

Back 27

may request medication when pain becomes severe

Front 28

Culture and Pain

-Southeast Asian women and pain?

Back 28

may endure severe pain before requesting relief

Front 29

Culture and Pain

Hispanic women and their response to pain?

Back 29

-may be stoic until late in labor when they become vocal and request pain relief

Front 30

Culture and Pain

what women may use medication or remedies made from plants

Back 30

-Native American

Front 31

Culture and Pain

what women may express pain openly, use of meds for pain relief varies

Back 31

-African American

Front 32

-Anxiety:
-more common with increased pain during labor
-mild anxiety is considered normal for a woman during labor and birth


what can excessive anxiety and fear cause?

Back 32

- more catecholamine secretion which increases stimuli to the brain from the pelvis b/c of decreased blood flow and increased muscle tension, which magnifies pain
perception

Front 33

-Anxiety:

-as anxiety and fear heighten
what increases: (2)
what decreases:

which can eventually do what to the progress of labor?

Back 33

muscle tension increases,

discomfort increases

effectiveness of uterine contractions decrease,


which can eventually slow the progress of labor

Front 34

-Previous experience:

-childbirth for a healthy young adult woman may be her first experience w/ pain and may not have developed what?

Back 34

effective pain coping strategies

Front 35

-Previous experience:

-for women who had a difficult and painful previous birth experience, what may lead to an increase perception of pain

Back 35

anxiety and fear from this past
experience

Front 36

-Previous experience:

-sensory pain for (multiparous of nulliparous) is greater during early labor

Back 36

-nulliparous

Front 37

-Previous experience:

-during the transition phase of the 1st stage of labor and during the 2nd stage of labor (multiparous of nulliparous) woman may experience greater sensory pain?

why?

Back 37

multiparous

b/c of their supple (bendable)
tissue increases the speed of fetal descent which increases pain

Front 38

-Previous experience:

-the firmer tissue of nulliparous women results in a (fater or slower) descent

Back 38

slower, more gradual

Front 39

-Previous experience:

-affective pain is greater for (multiparous or nulliparous) woman the 1st stage of labor

Back 39

nulliparous women

but decreases for both
nulliparous and multiparous women during the 2nd stage

Front 40

-Previous experience:

what 2 things can magnify pain

Back 40

-fatigue and sleep deprivation

Front 41

-Gate control theory of pain:

-pain sensations travel along sensory nerve pathways to the brain but only a limited number of sensations, or messages, can travel through these nerve pathways at one time

so what should the nurse do?

Back 41

using distraction techniques (massage, stroking, music, focal points, imagery) reduce or block the capacity of nerve pathways to transmit pain

-cognitive work (concentration on breathing and relaxation techniques) help as well

Front 42

Gate control theory of pain:

if the laboring woman engages in what kind of pain, it will modify the transmission of pain?

Back 42

neuromuscular and motor activity (activity within the spinal cord)

Front 43

-Comfort:

-the most helpful interventions to enhance comfort are

Back 43

a caring nursing approach and supportive
presence

Front 44

-Support:
continuous support begun early in labor does what?

relieves?
improves?
decreases? (2)

Back 44

-relieves pain,
improves outcomes,

decreases interventions (meds for pain) and complication rates (cesarean births) associated labor and enhances overall maternal
satisfaction

Front 45

-Support:

-a more positive effect is when the continuous support was provided by who?

Back 45

a woman who was not part of the staff of hospital

Front 46

quality of envt can help a woman cope with pain during labor

examples:

Back 46

-comfortable, homelike setting
-safe and private
-light, noise, and temperature should be adjusted according to the woman’s preferences
-enough space for movement
-birth balls, comfortable chairs, tubs, showers should be readily available for pain relief

Front 47

-Breathing Techniques

-breathing techniques provide distraction by

Back 47

reducing the perception of pain and helping the woman maintain control throughout contractions

Front 48

-Breathing Techniques
1st stage

breathing techniques are used for what reason? (2)

Back 48

promote relaxation of the abdominal muscles

increase the size of abdominal cavity (this lessens discomfort generated by friction b/w the uterus and abdominal wall
during contractions)

Front 49

-Breathing Techniques
2nd stage

-breathing is used to

Back 49

increase abdominal pressure and assist in expelling the fetus

Front 50

-Breathing Techniques
2nd stage

-breathing can also be used to prevent

Back 50

expulsion of the fetal head

Front 51

-Breathing Techniques

what is the berathing technique most associated with prepared child birth and includes slow paced, modified-paced, patterned paced breathing techniques

Back 51

-paced breathing

Front 52

-Breathing Techniques

-slow paced breathing:
what happens with the womans breathing rate?
-how do we know when we should implement this technique?

how long should this be used?

Back 52

half of the woman’s normal breathing rate is initiated

-when the woman can no longer talk or walk through contractions



-use this technique for as long as it’s effective in reducing the perception of pain & maintaining control

Front 53

-Breathing Techniques

-slow paced breathing:
how many breaths per minute?
what is the sequence?

Back 53

-approx 6-8 breaths per minute


-in-2-3-4/out-2-3-4

Front 54

-Breathing Techniques

-modified paced breathing:
how do we know when to change to this breathing pattern?

Back 54

-as the contractions increase in frequency and intensity, the woman needs to change to a more complex
breathing technique which is shallower and 2x her normal rate of breathing

Front 55

-Breathing Techniques

-modified paced breathing:
requires what?
why is it better than slow paced breathing?

Back 55

more concentration

blocks more painful stimuli than slow paced breathing

Front 56

-Breathing Techniques

-modified paced breathing:

how many breaths per minute?
what is the sequence like?

Back 56

-approx 32-40 breaths per minute)
-in-out/in-out

Front 57

-Breathing Techniques

-modified paced breathing:

what is the data of why this is a good breathing technique?
(3 things)

Back 57

-conserves energy,
-lessens fatigue,

-decrease the chance of hyperventilation

Front 58

-patterned paced breathing technique:

what the most difficult time to maintain control of breathing?

Back 58

during contractions is when the cervix dilates from 8-10 cm
(this phase is called the transition phase of the 1st stage of labor)

Front 59

transition phase of the 1st stage of labor is suggested for what breathing technique

Back 59

-patterned paced breathing technique:

Front 60

-patterned paced breathing technique:

what is the breathing pattern?

what is the sequence?

Back 60

-4:1 pattern

(breath, breath, breath, breath, blow (blow out a candle)

Front 61

-patterned paced breathing technique:

-SE:

Back 61

hyperventilation

Front 62

-patterned paced breathing technique:

-SE:
-watch for symptoms of respiratory (acidosis or alkalosis)
what are the s/s?

Back 62

-respiratory alkalosis

-light headedness, dizziness, tingling of fingers, circumoral numbness

Front 63

-patterned paced breathing technique:

-SE: hyperventilation

how can you treat that?

Back 63

-respiratory alkalosis may be eliminated by having the woman breathe into a paper bag or into her cupped hands if no bag is available

(rebreathe carbon dioxide and replace bicarb)

Front 64

2nd stage of labor and breathing pattern?

what pattern should she use?

what should she make sure to avoid?

Back 64

-the woman should find a breathing pattern that is relaxing and feels good to her and the baby

-avoid prolonged breath holding

Front 65

-when the fetal head reaches the pelvic floor, the woman may feel the urge to push

what can be used to overcome the urge to push when the cervix is not fully prepared?

Back 65

by taking panting breaths or by slowly exhaling through pursed lips

Front 66

effleurage is:


why is it used?

Back 66

light massage, usually of abdomen, in rhythm with breathing during contractions


-used to distract the woman from contraction pain

Front 67

effleurage is relief to many women during what stage of labor?

Back 67

- 1st stage of labor

Front 68

-counterpressure is

Back 68

steady pressure applied by a support person to the sacral area with the first or heel of the hand

Front 69

counterpressure
-helps the woman do what?

Back 69

-cope with sensation of internal pressure and pain in the lower back

Front 70

what is really helpful when back pain is caused by pressure of occiput against spinal nerves from the fetal head

Back 70

counterpressure

Front 71

Transcutaneous electrical nerve stimulation (TENS)

what happens?

Back 71

-places 2 pairs of flat electrodes on either side of the woman’s thoracic and sacral spine providing a continuous low intensity of electrical impulses

Front 72

Transcutaneous electrical nerve stimulation (TENS)

during contraction, the women increases the stimulation from low to high
-high intensity should be maintained for how long? why?

Back 72

-high intensity should be maintained for at least 1 min to release endorphins

Front 73

Transcutaneous electrical nerve stimulation (TENS)

mots useful for which stage of labor and why?

Back 73

-early first stage of labor

most useful for lower back pain

Front 74

Transcutaneous electrical nerve stimulation (TENS)

-Risk to mom or fetus?

Back 74

no risks for mom or fetus

Front 75

Transcutaneous electrical nerve stimulation (TENS)

may be effectice why?

Back 75

- because of the placebo effect

(confidence that the TENS stimulate release of endorphins thus alleviatng discomfort)

Front 76

Acupressure and Acupuncture

used to: (2)

Back 76

-relieve pain and discomfort

-may also be given to reduce nausea when an opioid is used

Front 77

Acupressure and Acupuncture

acupressure is thought to increase the levels of:

Back 77

endorphin levels which help with discomfort

Front 78

acupressure
-pressure is applied with the hell of the hand, fist, or pad of thumbs and fingers
-tennis balls can also be used

-acupressure points are found on the neck, shoulders, wrist, lower back, hips, below kneecaps, ankles,
nails on small toes, and soles of feet

when is pressure applied?

Back 78

-pressure is applied with contractions initially and then continuously as labor progresses to the end of
the first stage of labor

Front 79

Sedatives
-what are they given for?

Back 79

relieve anxiety and induce sleep

Front 80

Sedatives
-may be given to a woman in what stage of labor?

Back 80

experiencing prolonged latent phase of labor

Front 81

-barbiturates such as (Seconal) can cause undesirable SE such as: (2)

Back 81

(respiratory and vasomotor depression)

Front 82

When are Benzodiazepines useful?


what do they help with?
what do they reduce?
what do they increase?

Back 82

when given with an opioid analgesic

- pain relief
-reduce n/v,
increased sedation

Front 83

Timing of administration

chain of command to get the woman meds?

Back 83

-the nurse notifies the doctor that the woman is in need of pharmacologic measures to relief her discomfort

Front 84

Timing of administration

-pharmacologic measures for pain relief are not usually implemented until labor has advanced to what phase?

Back 84

the active phase of the 1st stage of labor and the cervix is dilated approx 4-5cm

Front 85

visceral pain
-what stage of labor is this felt?

caused by: Cervical changes, lower uterine segment distention, and uterine ischemia
WHERE is this pain felt?

Back 85

1st stage

- lower abdomen

Front 86

Referred pain
-originiates where?

-radiates to?

Back 86

Originates in uterus,

radiates to abdominal wall, lumbosacral area, iliac crests, gluteal area, and down thighs,

Front 87

Viseral somatic or referred pain

what is contraction pain?

Back 87

referred pain

Front 88

Somatic pain
-what stage is this felt?

-what does it feel like?

Back 88

Second stage of labor

Intense, sharp, burning, well localized

Front 89

Culture and pain

______ quiet and still, they don’t breath faster or tense up

Back 89

Hmong pts

Front 90

Breathing techniques
-1st stage (relax or push) -breath fast or slow?
-2nd stage (relax or push) -breath fast or slow?

Back 90

1st stage to relax, breath as slow as possible


2nd stage to push ,panting

Front 91

Application of heat/cold
Culture may dictate -

______ patients, don’t’ want anything cold. They don’t’ want ice water, they want hot water. No ice backs on bottom, plain pads.

Back 91

Hmong

Front 92

Hypnosis - when is it started?


Biofeedback- what is this about?
what do you cause your body to do?

Back 92

Hypnosis -people start it usually prior to

Biofeedback-really being able to know your body.

Your causing your body to respond to what you want it to do. “im going to relax”

Front 93

Nonpharmacologic Management of Discomfort

Aromatherapy – can do what

Back 93

Aromatherapy –can make people happy and help them relax

Front 94

Nonpharmacologic Management of Discomfort

Intradermal water block
-what is it

Back 94

sterile water injection in the lower back, stings for 20-30 seconds and then they get good lower back relief, lasts for awhile and you may have to do it again

Front 95

Sedatives
-Relaxes and potentiates what effects

Back 95

opioid analgesic

Front 96

Sedatives


increase or decrease N/V

Back 96

decrase

Front 97

Dilaudid, Demerol, Fentanyl
are examples of?

Back 97

Opioid agonist analgesics

Front 98

Dilaudid, Demerol, Fentanyl
-pain relief compared to an epidural?

what does it cause?

Back 98

Less pain relief than epidural

Causes respiratory depression

Front 99

Dilaudid, Demerol, Fentanyl
(Opioid agonist analgesics)

do not administer when? (2)

why?

Back 99

after 7 cm dilation,
2 hours prior to delivery

-fetal exposure CNS depression

Front 100

Stadol, Nubain –given IV

what class are they??

Back 100

Opioid agonist-antagonist analgesics

Front 101

Stadol, Nubain –given IV

analgesia or anesthesia?

Back 101

Analgesia

Front 102

Stadol, Nubain –given IV

why are they given?

Back 102

Analgesia without respiratory depression

Front 103

What do you not want to use in women who are opiod dependent, they will experience immediate withdrawal

Back 103

Stadol, Nubain –given IV