Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
OB discomfort
discomfort, childbirth prep, nonpharm/pharm: roles, limits, advantages
| Question | Answer |
|---|---|
| how does childbirth pain differ from other | normal process not connected to injury/illness, several months to prepare for pain mgm, realistic preparation and knowledge help develop skills to cope, self limiting pain that rapidly declines after birth, |
| what are four sources of labor pain? | dilation/stretching of cervix and lower uterus, tissue ischemia leading to tissue hypoxia/anaerobic metabolism, pressure and pulling on pelvic structures i.e. ligaments, fallopian tubes, ovaries, bladder, perineum, stretching of vagina/perineum may burn |
| what is secreted after excessive pain that may heighten a woman's fear and anxiety? | fear and anxiety stimulates th4 sympathetic nervous system activity and results in catecholamine secretion |
| what are the effects of catecholamines? | excessive catecholamines result in reduced blood flow to and from the placenta which restricts fetal oxygen supply and waste removal, reduced effectiveness of uterince contractions, slowing labor progression. |
| poorly relieved pain also lessens the pleasure of this life event. unpleaasant memories may affect the woman's response to ? | sexual activity or another labor. |
| what influences perception and tolerance of pain? | cervical readiness: contrxns 4 dilation/effacement; pelvis:size/shape affect course/length of labor; labor intensity: short labor-painful.percontra long labor; fatigue: reduces pain toloerance, copeskil usability; fetal position:back labor, abnormal pres. |
| what are interventions of care givers that may cause discomfort? | IV's, fetal montioring, induction of labor because cntractions reach peak intensity quick, vaginal examinations, amniotomy and insertion of internal fetal montior b/c they involve vaginal and cerivcal stretching |
| Psychological factors that influence pain | culture influences how a woman feels about pregnancy and birth, how she reacts, anxiety and fear if excessive may have detrimental effects on both the mom and babe, techniques to moderate anxiety may increase pain tolerance |
| how does previous pain experience affect pain in labor? | other than labor pain experiences may provide coping skills. Previous labor may make woman apprehensive |
| childbirth education should prepare realistically what? | for pain and reasonable expectations about analgesia/anesthesia, preparation for childbirth does not ensure pain free labor. |
| Nonpharmacological methods: | relaxation/stimulation, Environmental measures, music, cold cloth on forehead, keeping the woman focused on childbirth, cutaneous stimulation, massage, counter pressure, touch, thermal stim, hydrotherapy, mental stim, breathing |
| pharmacological | systemic drugs, regional pain management, general anesthesia, |
| how is the fetus affected? | direct resulting from the passage of the drug across the placenta to the fetus, indirect/secondary to drug effects in the mother |
| Maternal physiological alterations of cardiovascular | compression of the aorta and inferior vena cava by the uterus can occur when a woman lies in the supine position, place a small wedge or towel under one hip to displace uterus to one side |
| Maternal physiological alterations of the respiratory | compensation by breathing more rapidly and deeply, more vulnerable to decerased arterial oxygenation when using general anesthesia, may be more difficult to intubated due to edema of her upper airways secondary to pregnancy. |
| maternal physiological alterations of the gastrointestinal | woman's stomach is displaced upward by the uterus and has higher internal pressure, hormonal changes make a pregnant woman more bulnerable to regurgitation/aspiration of gastic contents during general anesthesia, |
| maternal physiological alterations of the nervous system? | During pregnancy and labor, the circulating levels of endorphins are high, modifies pain perception and reduces the requirement for analgesia and anesthesia, epidural and subarachnoid spaces are smaller during pregnancy, enhancning spread of anesthetic |
| when is pain med given for labor? | Ideally pain meds are given when labor is well established. be careful with CVD, and herbal remedies that cause complications |
| What pain mgm may be used for intrapartum analgesia, surgica anesthesia or both. these methods provide pain relief without loss of consciousness? | Regional pai management |
| a popular block that provides anaglesia and anesthesia for labor and birth without sedation of the woman and fetus | Epidural: local anesthetic agent usually combined with an opioid is injected into the epidureal space for pain relief without inhibiting ability to respond to contractions |
| contraindications and precautions include women with? | coagulation defects, uncorrected hypovolemia, infection of area of insertion, severe systemic infections, allergy, fetal condition that demands immediate birth. |
| adverse effects affecting bp | maternal hyptension due to blocking sympathetic nerves resulting vasodilation/hypotension; treated by fluid infusion |
| adverse effects affecting the bladder? | distention resulting from infusion of large quantity of IV solutions coupled with the woman's inability to feel that her bladder is full |
| adverse effects affecting contractions/ | Prolonged second stage of labor because theurge to push is less intense tha if a woman does not have an epidureal block. the pelvic muscles may also be relaxed which can interfere with the mechanism of internal rotation, increase chance of forcep/vaccuum |
| adverse effects affecting location of the block | catheter migration due to the catheter moving after insertion causing symptoms ofintravascular injection with unilateral anesthetic effect, not present, or block is too high |
| adverse effects affecting delivery | Cesarean birth may result, but there is no exact correlation with epidurals, |
| maternal fever is not totally clear either. why? | fever may be caused from reduced hyperventilation and decreased heat dissipation such as reduced sweating that occur when the woman's pain is relieved, lower temp and id suspect infection |
| Epidural opioids s/e include | N/V, pruritis, delayed maternal resp depression, |
| nursing Care of a mother with an epidura includes: | recording baseline VS and FHR, patterns for comparison with prenatal levels and those after the epidural |
| May a pt with an epidural be allowed to walk or stand alone? | no. woman must be able to at a minimum , raise and move her legs prior to ambulating |
| intrathecal Opioids Analgesics provid another option for pain management without sedation. how does it work? | drug is injected into the subarachnoid space where it binds to opiat receptors and provides pain relief, woman can feel her contractions without the pain that usually accompanies them, |
| Advantages | rapid onset of pain relief without sedation, no motor block enables woman to walk, no sympathetic block with potential hypotensive s/e |
| disadvantages? | limited duration of action requirintg another procedure for continued pain relief, inadequate pain relief for late labor and the birth |
| Intrathecal opioids | may also be combined with an epidural block in a CSE, in which the woman receives the intrathecal opioid for rapid pain control at the time an epidural catheter is plaaced. epidural drugs for long acting block for labor |
| technique | subarachnoid space with spinal needle, preservative free opioid analgesic is injected (fentynal, morphine); thinnr spinal needle inserted through larger epidural to reach subarachnoidspace 4 intrathecal, epidural catheter inserted after w/drawl of needl. |
| adverse effects of intrathecal opioids are | Delayed maternal respiratory depression may also occur depending on th med used. the same as with epidurals, nausea, vominting and pruritis may occur. |
| nursing care may inlcude: | VS/FHR, report s/s of s/e (N/V or decreased effectiveness) |
| SAB-Subarachnoid (spinal ) block | local anesthetic is injected into the subarachnoid space in a single dose. CSF at needle hub assures correct placement. woman loses sensory and motor function below thelevel of the lbock with relief of pain from contractions, |
| Contraindications | refusal, coagulation defects, uncorrected hypovolemia, infection at insertion, infection systematically, allergy |
| adverse reaction | maternal hypotn, bladder distencio, pstdural puncture h/s, worsens when woman is upright/oral caffeine for relief, blood patch 10-15ml of womans blood into epidural space |
Created by:
redhawk101
Popular Nursing sets