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56 Cards in this Set
- Front
- Back
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Pain during the 1st stage of labor is what type of pain?
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Visceral pain, and typically only occurs during contractions.
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What causes visceral pain?
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In the first stage of labor, visceral pain is caused by cervical changes, distension of the lower uterine segment, and uterine ischemia.
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Which nerves transmit pain during the first stage of labor?
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T11 and T12 and accessory lower thoracic and upper lumbar sympathetic nerves. These nerves originate in the uterine body and cervix.
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What positions provide relief during labor and why?
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Upright positions, when assumed during labor, typically result in decreased pain. Freedom of movement also decreases pain. Perhaps this is because sympathetic nerves are causing the pain and restriction of movement increases anxiety when our nervous system is in a fight or flight state.
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What type of pain is most common during the second stage of labor?
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Somatic pain is more often caused by the destruction of tissue. It's described as intense, sharp, burning and well localized. It results from stretching and distension of perineal tissues and the pelvic floor and from lacerations of soft tissue (cervix, vagina, perineum)
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What nerves are involved in the second stage of labor?
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Pudendal nerve, S2 thru S4 and the parasympathetic system.
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Pain causes what physiological changes?
(bp, co, O2, etc) |
Increased cardiac output because of
Increased heart rate because of Increased Oxygen demands Increased B.P. and Increased R.R. |
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How do distraction techniques help with pain?
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Gate control theory:
distraction limits the capacity of nerve pathways to carry pain messages. |
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What physiological change does slowing breathing cause?
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Slows heart rate
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What type of breathing is appropriate during the Latent phase of labor?
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slow chest breathing (6-8/min)
During contraction use modified paced breathing (32-40/min) |
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If a woman is feeling the urge to push but is not fully dilated, what breathing should she do?
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panting
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What could happen to the progress of labor if a woman heeds the urge to push before she is fully dilated?
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edematous cervix, stalling of labor due to smaller cervix
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Excessive release of catecholamines can cause ______.
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Prolonged labor can be a result of pain becoming too severe.
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Opioids are associated with longer/shorter labors than epidurals?
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shorter
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Epidurals are associated with greater/fewer assisted deliveries (forceps, oxytocin)
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greater
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Greater satisfaction with pain relief is reported from women using opioids/epidurals?
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epidurals
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What is given to the newborn suffering from neonatal narcosis?
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Narcan, an opioid antagonist
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What drugs might be given to a woman in the latent stage of labor?
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parenteral narcotics, typically given with zofran or another anti emetic to prevent nausea/vomiting.
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Do parenteral narcotics cross the placenta? What effects do they have?
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Yes. They may cause neonatal respiratory depression, sedation and the heart rate will not fluxuate as much.
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What preparations should a nurse make when a parenteral narcotic has been given within two hours prior to delivery?
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Get neonatal team to treat potential neonatal depression (narcan I.M.)
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What safety interventions can a nurse perform for a woman who has received parenteral narcotics?
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Side rails up and assistance with ambulation.
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When and why would a pudental block be used?
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Rarely used, but would occur during 2nd stage of labor for relief from pain of stretching and tearing of perineum and repair of episiotomy
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What type of block has been discontinued because of its risk of fetal bradycardia?
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Paracervical block
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Where is a spinal block placed?
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Subarachnoid layer of spine in the 3rd, 4th, or 5th lumbar space.
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What are adverse effects of spinal blocks?
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*Hypotension, impaired placental perfusion and an ineffective breathing pattern
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What is it critical for the nurse to ensure before a client receives a spinal block or an epidural?
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Must be assessed for hypovolemia. The vasodilation caused by these interventions can be severe if there is a fluid imbalance. Often a bolus is given regardless of her fluid status to prevent hypotension.
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What medication is commonly administered in a spinal block?
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Lidocaine
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How long does a spinal block last?
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Spinal blocks last 2-4 hours and consist of only a single injection.
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Under what circumstances would a spinal block be given?
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C section (if everyone is ready to go!)
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What is the standard of care for an emergency C section?
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30 minutes from decision to incision
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What is one advantage of a spinal block over an epidural?
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Spinal blocks are easier to administer.
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Where is an epidural placed?
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Between dura mater and vertebral canal.
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Does an epidural mix with cerebral spinal fluid?
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No. The space where an epidural is placed is filled with blood vessels, fat and connective tissue.
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What is a primary advantage of an epidural over a spinal block?
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blocks transmission of painwithout central of respiratory depression.
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Can a woman feel anything when she has had an epidural?
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She can feel movement and pressure, but not pain
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What does the most current research show about the correlation between epidurals and C sections?
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There is no increased risk of C section with an epidural.
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What medication is commonly administered in a spinal block?
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Lidocaine
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How long does a spinal block last?
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Spinal blocks last 2-4 hours and consist of only a single injection.
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Under what circumstances would a spinal block be given?
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C section (if everyone is ready to go!)
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What is the standard of care for an emergency C section?
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30 minutes from decision to incision
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What is one advantage of a spinal block over an epidural?
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Spinal blocks are easier to administer.
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Where is an epidural placed?
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Between dura mater and vertebral canal.
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Does an epidural mix with cerebral spinal fluid?
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No. The space where an epidural is placed is filled with blood vessels, fat and connective tissue.
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What is a primary advantage of an epidural over a spinal block?
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blocks transmission of painwithout central of respiratory depression.
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Can a woman feel anything when she has had an epidural?
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She can feel movement and pressure, but not pain
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What does the most current research show about the correlation between epidurals and C sections?
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There is no increased risk of C section with an epidural.
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What is the major maternal complication for lumbar epidurals?
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Hypotension, watch trending BP's.
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A side effect of epidurals, postpartum headache, is caused by what?
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Leaking of CSF from site of needle insertion when it is inserted too far (all the way into the spinal fluid) . The needle used for this is large and when CSF leaks out, negative pressure occurs and a severe HA can result.
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What nursing interventions can be performed to relieve this headache?
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Lying a woman on her stomach to prevent CSF from leaking out can work, but is difficult postpartum.
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What is a "walking" epidural?
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This is the most common, narcotic meds are pumped into the epidural site on a regular basis. No pain, but movement can be felt. Clients may be dizzy or have orthostatic hypotension.
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What is a standard fluid bolus for someone receiving an epidural ?
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500-1000 ml. This decreases chances of hypotension.
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General anesthesia is used when?
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Very rarely, only if there is a contraindication to a spinal block/epidural or if there is not sufficient time to place a block.
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Marked obesity, neck edema, short stature, asthma. preeclampsia, complications should all be relayed in what situation?
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If present, these factors should be relayed to the anesthesiologist in the event the patient is in a critical situation
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What is a "wet tap" during placement of an epidural?
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When the needle goes past the epidural space into the CSF. May result in severe headache postpartum.
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Coagulation disorders and infection are contraindications for what type of pain relief during labor?
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Epidural
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What is preferred pain relief during labor?
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Good support, calm environment, ability to move freely, having a plan for the tough times, and being open to all the available options:)
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