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33 Cards in this Set
- Front
- Back
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During labor pain has 2 origins |
somatic and visceral |
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during 2nd stage of labor pain results from |
-distention and traction on the peritoneum and uterocervical supports during contractions -pressure against the bladder and rectum - stretching and distention of perineal tissues and the pelvic floor to allow passage of the fetus -laceration of soft tissue (cervix, vagina and perineum) |
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during 1st stage of labor pain |
- is transmitted through the T10-T12 and L1 spinal nerve segments and accessory lower thoracic and upper lumbar sympathetic nerves. These nerves originate in the uterine body and cervix |
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third stage of labor and after pains |
-after pains refers to the pain felt in the early postpartum period - uterine, similar to the location of pain in the first stage. |
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Pain threshold |
- similar in everyone regardless of gender, social, or cultural differences, these differences play a definite role in the person's perception of and behavioral responses to pain. |
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Pain tolerance |
- refers to the level of pain a laboring woman is willing to endure
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factors that influence pain tolerance in laboring woman |
- her desire for a natural/vaginal birth, her preparation for childbirth , the nature of her support during labor, and her willingness and ability to participate in nonpharmacologic measures for comfort. - variety of physiologic , psychologic, emotional, social, cultural, and environmental factors. |
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anxiety and pain perception |
- excessive anxiety and fear cause more catecholamine secretion, which increases the stimuli to the brain from the pelvis because of decreased blood flow and increased muscle tension and this magnifies pain perception. |
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measures for supporting woman in labor |
- provide companionship and reassurance - offer positive reinforcement and praise her efforts - encourage participation in distraction activities and nonpharmacolgic measures for comfort -give nourishment (if allowed by HCP) - assist with personal hygiene - offer information and advice - involve woman in decision making regardless her care - interpret the woman's wishes to other HCP's and her support group - create a relaxing environment - use a calm and confident approach - support and encourage family members by role modeling labor support measures and providing time for breaks. |
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Nonpharmacologic strategies to encourage relaxation and relieve pain |
-Cutaneous Stimulation Strategies: counterpressure, effleurage (light massage), therapeutic touch and massage, walking, rocking, changing positions, application of heat or cold, TENS, acupressure, water therapy (showers, whirlpool baths), intradermal water block. - Sensory stimulation strategies: aromatherapy, breathing techniques, music, imagery, use of focal points - Cognitive Strategies: childbirth education, hypnosis, and biofeedback
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Cleansing breath |
- relaxed breath in through the nose and out through the mouth. Used at the beginning and end of each contraction. |
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Effleurage |
is light stroking, usually f the abdomen, in rhythm with breathing during contractions. It is used t distract the woman from contraction pain. may be uncomfortable and less effective when hyperesthesia (hypersensitivity to touch) |
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Counterpressure |
- is steady pressure applies by a support person to the sacral area with a firm object (tennis ball) or the fist or heel of the hand. Pressure can also be applied to both hips (double hip squeeze) or to the knees. Helps the woman cope with the sensations of internal pressure and pain in the lower back. |
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intradermal water block |
- involves the injection of small amounts of sterile water by using a fine gauge needle into four locations on the lower back to relieve low back pain. |
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pharmacologic control of discomfort in stage 1 |
- opioid agonist analgesics (demerol, fentanyl) - opioid agonist-antagonust analgesics (stadol, Nubain) -epidural (block) analgesia - combined spinal epidural analgesia - nitrous oxide |
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pharmacologic control of discomfort in stage 2 |
- nerve block analgesia and anesthesia: local infiltration anesthesia, pudendal block, spinal block anesthesia, epidural block analgesia, CSE analgesia - nitrous oxide |
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pharmacologic control of discomfort in vaginal birth |
- local infiltration anesthesia - pudendal block - epidural (block) analgesia and anesthesia - spinal (block) anesthesia - CSE analgesia and anesthesia - nitrous oxide |
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pharmacologic control of discomfort in cesarean birth |
-spinal (block) anesthesia - Epidural (block) anesthesia - general anesthesia |
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anesthesia |
- encompasses analgesia, amnesia, relaxation and reflex activity - abolishes pain perception by interrupting the nerve impulses to the brain - the loss of sensation may be partial or complete, sometimes with the loss of consciousness - type chosen depends on the stage of labor woman is in and method of birth planned |
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analgesia |
- refers to the alleviation of the sensation of pain or the raising of the threshold for pain perception without loss of consciousness - type chosen depends on the stage of labor woman is in and method of birth planned. |
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signs of potential maternal opioid abstinence Syndrome (opioid/narcotic withdrawal) |
-yawning, rhinorrhea (runny nose), sweating, lacrimation (tearing), mydriasis (dilation of pupils) - anorexia - irritability, restless, generalized anxiety -tremors - chills and hot flashes - piloerection ("gooseflesh" or "chill bumps") - violent sneezing - weakness, fatigue, and drowsiness - diarrhea, abdominal cramps - bone and muscle pain, muscle spasms, kicking movements. |
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regional analgesia
regional anesthesia |
- some pain relief and motor block
- complete pain relief and motor block |
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- subarachnoid space |
- where the anesthesia solution mixes with cerebrospinal fluid - where spinal anesthesia is placed |
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advantages of spinal anesthesia |
- ease of administration and absence of fetal hypoxia with maintenance of maternal blood pressure within a normal range - maternal conscious is maintained, excellent muscular relaxation is achieved and blood loss is not excessive |
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- disadvantages of spinal anesthesia |
- possible medication reactions, hypotension, and ineffective breathing pattern; cardiopulmonary resuscitation may be needed. - voluntary elimination is decreased and possible postural puncture is a headache
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maternal hypotension with decreased placental perfusion |
- maternal hyotension (20% decrease from preblock baseline level) - fetal bradycardia - absent or minimal fetal heart rate variability -Interventions: turn woman to lateral position or place pillow or wedge under hip to displace uterus; maintain IV infusion at rate specified or increased administration per protocol; administer oxygen by nonrebreather face mask at 10-12 liters per minute; elevate woman's legs; notify PHCP, anesthesiologist or nurse anesthetist; administer IV vasopressor; remain with woman, and continue to monitor maternal bp and FHR every 5 min until her condition is stable or per primary HCP's order
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autologous epidural blood patch |
-is most rapid, reliable, and beneficial relief measure for spinal headache. the woman's blood is injected slowly into the lumbar epidural space, creating a clot that patches the tear or hole in the dura mater. |
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advantages of epidural block |
- the woman remains alert and is more comfortable and able to participate - good relaxation is achieved - airway reflexes remain intact - only partial moor paralysis develops - gastric emptying is not delayed - blood loss is not excessive |
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disadvantages of epidural and spinal anesthesia |
- hypotension - Local anesthetic toxicity: lightheadedness, dizziness, tinnitus, metallic taste, numbness of tongue and mouth, bizarre behavior, slurred speech, convulsions, loss of consciousness - high or total spinal anesthesia -fever - urinary retention - pruritus (itching) - limited movement -longer second stage labor - increased use of oxytocin - increased likelihood of forceps or vacuum assisted birth |
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intrathecal opioids |
- opioids administered in this manner do not cause maternal hypotension or affect vital signs, woman feels contractions but no pain, ability to bear down in stage 2 is preserved because the pushing reflex is not lost and her motor power remains intact. - fentanyl, sufentanil, or preservative free morphine - side effects: nausea, vomiting, diminished peristalsis, pruritus, urinary retention and delayed respiratory depression. |
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General anesthesia |
- is used for uncomplicated vaginal birth - may be needed is a spinal or epidural block is contraindicated or if indications necessitate ra[id birth (vaginal or emergent cesarean) without sufficient time or available personnel to perform block. |
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Iv route advantages with pain medication |
- onset of pain relief is rapid and more predictable - pain relief is obtained with small doses of the drug - duration of effect is more predictable |
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IM route disadvantages with pain medication |
- onset of pain relief is delayed - higher doses of medication are required - medication is released at an unpredictable rate from the muscle tissue and is available for transfer across the placenta to the fetus |
