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NURS 372 (Midterm) > Intrapartum 2 (Pain Management) > Flashcards

Intrapartum 2 (Pain Management) Flashcards

1
Q

Beta-endorphines are released by which gland? What do they do?

A

Released/secreted by the pituitary gland that act on the CNS and PNS to reduce pain

They are associated with feelings of euphoria and analgesia

-The pain threshold may increase as beta-endorphin levels increase enabling patients in labour to better tolerate pain

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2
Q

What happens to the mothers blood pressure in response to pain during labour?

A

Increases during contractions and may increase with pain

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3
Q

When is sensory pain greater for nulliparous patients? Why?

A

Sensory pain for nulliparous patients is often greater than that for multiparous patients during early latent labour (dilation less than 4 cm) because their reproductive tract structures are less supple.

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4
Q

Examples of sensory stimulation strategies that can be used as pain relief during labour?

A

Aromatherapy
Breathing techniques
Music
Imagery
Use of focal points

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5
Q

What must the nurse assess for when taking into account how culture can influence labour pain?

A

The nurse must assess the patient for the physiological effects of pain and listen to the words the patient uses to describe the sensory and affective qualities of the pain.

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6
Q

Examples of non-pharmalogical Cutaneous Stimulation Strategies for pain relief during labour

A

Counterpressure

Effleurage (light massage)

Therapeutic touch and massage

Walking

Rocking

Changing positions

Application of heat or cold

Transcutaneous electrical nerve stimulation (TENS)

Acupressure/acupuncture

Hydrotherapy (showers, bath)

Intradermal water block

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7
Q

What are some maternal complications of a epidural?

A

Maternal complications: *hypotension, N&V, fever, pruritis, intravascular injection, respiratory depression

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8
Q

What does a visual pain scale allow women in labour to do?

A

A visual analog scale allows the woman to indicate on a
line how severe or intense she perceives her pain to be

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9
Q

At what point during labour should opioid agonist analgesics be administered?

A

They should not be administered until labour is well established because they can inhibit uterine contractions

*Only exception to this is unless they are being used to enhance therapeutic rest during a prolonged latent phase of labour

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10
Q

What kind of disadvantage/negative effect can an epidural have on the fetus during labour?

A

Effects on fetus during labour: fetal distress secondary to maternal hypotension

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11
Q

What can occur in the immediate postpartum period? (This is a disadvantage of an epidural)

A

Urinary retention and stress incontinence can occur in the immediate postpartum period

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12
Q

What is continuous labour support recommended for? What does it aim to provide?

A

“Recommended for all women in active labour. Each labour unit should aim to provide the opportunity for each woman to receive continuous 1-to-1 labour support”

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13
Q

What kind of pharmalogical pain managament can a labouring patient have in the second stage of labour?

A

Nerve block analgesia/anaesthesia
*Local infiltration anaesthesia
*Pudendal block
*Epidural (block) analgesia and anaesthesia
*Spinal (block) anaesthesia
*Nitrous oxide

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14
Q

When can Nitrous Oxide (Entonox) be used during labour and in combination with?

A

It can be used during the first and second stages of labour and can be used in combination with other nonpharmacological and pharmacological measures for pain relief

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15
Q

What does the gate-control theory state about pain?

A

According to this theory, 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.

Using distraction techniques, such as massage or stroking, music, focal points, and imagery, reduces or completely blocks the capacity of nerve pathways to transmit pain.

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16
Q

What emotional (affective) expressions of pain are seen during labour?

A

Such changes include increasing anxiety with lessened perceptual field, writhing, crying, groaning, gesturing (hand clenching and wringing), and excessive muscular excitability throughout the body.

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17
Q

What does continuous labour support include?

A

Includes continuous presence, emotional support, comfort measures, advocacy, information & advice

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18
Q

What can urinary retention be related to? (Think with the use of epidurals)

A

This temporary difficulty in urinary elimination could be related not only to the effects of the epidural block and catheterization done in labour but also to the increased duration of labour and need for forceps- or vacuum-assisted birth associated with the block.

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19
Q

How does hypotension occur as a result of with epidurals?

A

Hypotension as a result of sympathetic blockade can occur in about 14% of patients who receive epidural and 70% of patients who receive spinal anaesthesia during labour.

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20
Q

What is the nurse permitted to with when a patient has an epidural?

A

*Monitor the status of the patient receiving regional anaesthesia, the fetus, and the progress of labour
*Replace empty infusion syringes or bags with the same medication and concentration
*Stop the infusion if there is a safety concern or the patient has given birth
*Remove the catheter if properly educated to do so
*Initiate emergency measures if the need arises
*Communicate clinical assessments and changes in patient status to obstetrical and anaesthesia care providers

In some institutions the registered nurse may also alter the rate of medication infusion and administer bolus doses as ordered

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21
Q

What is considered to be the most helpful intervention in enhancing comfort during labour?

A

Using a caring nursing approach and providing a continuous supportive presence

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22
Q

What happens to the mothers cardiac output in response to pain during labour?

A

Increases with pain from contractions & anxiety

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23
Q

What specific opioid medication use is increasing for labourpain?

A

Sufentanil – use is increasing

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24
Q

What kind of pain is felt during the second stage of labour?

A

Somatic pain

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25
Q

What kind of pain predominates during the first stage of labour?

A

Visceral pain

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26
Q

During the first stage of labour where does pain originate from?

A

*Dilation of the cervix

During the first stage of labour, pain originates from the uterus and cervix.

Uterine contractions cause cervical effacement and dilation

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27
Q

Where is visceral pain generated from?

A

Visceral pain is generated from distension of the lower uterine segment, stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures (e.g., fallopian tubes, ovaries, ligaments) and nerves, and uterine ischemia that predominates during the first stage of labour

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28
Q

Examples of Systemic Analgesia that can be used for pain management during labour?

A

Opioid agonist analgesics: Fentanyl, Sufentanil, Morphine

Opioid agonist-antagonist analgesics:
Nalbuphine
(Nubane)

Opioid
antagonists:
Naloxone (Narcan

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29
Q

How does a PCA work?

A

With PCA, the patient self-administers small doses of an opioid analgesic intravenously by using a pump programmed for dose and frequency.

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30
Q

What can further delay gastric emptying during labour?

A

Use of opioid analgesics

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31
Q

What are the 5 benefits to providing continuous labour support (CLS)

A

1.) Increased likelihood of a vaginal delivery
2.) Decreased risk of a caesarean section
3.) Reduced use of epidural analgesia
4.) Increased Apgar score (This test checks a baby’s heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed)
5.) Increased maternal satisfaction

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32
Q

What is important for the nurse to recognize when thinking how culture influences labour pains

A

It is important for the nurse to recognize that, although a patient’s behaviour in response to pain may vary according to their cultural background, it may not accurately reflect the intensity of the pain being experienced.

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33
Q

When does the maximum therapeutic relif occur with Nitrous oxide?

A

The maximum therapeutic effect occurs approximately 50 seconds after continuous inhalation is commenced; therefore, beginning the inhalation process 30 seconds before the onset of a contraction (if regular) or as soon as a contraction begins (if irregular) provides the best pain relief.

34
Q

during what stage of labour may non-pharmacolgical pain relief methods be most effective?

A

During the latent or early active labour

35
Q

What do opioids readily cross?

A

The placenta

36
Q

How does Nitrous oxide reduce pain during labour?

A

Patients report that nitrous oxide does not completely relieve pain but reduces their perception of pain. It causes a feeling of euphoria and decreases anxiety.

37
Q

During labour when does referred pain occur?

A

Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, gluteal area, thighs, and lower back.

38
Q

What happens to the mothers respiratory system in response to pain during labour?

A

Oxygen demand and consumption increases
Respiration and pulse increase with pain

39
Q

What is the goal of an epidural block?

A

To provide sufficient anaesthesia with as little blockage to the sensory and motor nerves as possible

40
Q

What do opioids provide? When are they most effective? How long do they provide relief for?

A

Opioids provide sedation and euphoria, but their analgesic effect in labour is limited. The pain relief they provide is incomplete, temporary, and more effective in the early part of active labour.

41
Q

What kind of pharmalogical pain managament can a labouring patient have in the first stage of labour?

A

1.) Systemic analgesia
*Opioid agonist analgesics
*Opioid agonist–antagonist analgesics

2.) Epidural (block) analgesia

3.) Combined spinal–epidural (CSE) analgesia

4.) Nitrous oxide

42
Q

What blood value in a labouring mothers immune system increases during labour?

A

Increase in WBC

43
Q

What happens to a labouring mothers blood glucose levels in response to pain during labour?

A

It decreases

44
Q

Where is the injection made for a lumbar epidural block?

A

Injection is made between the fourth and fifth lumbar vertebrae for a lumbar epidural block

45
Q

Advantages to a epidural?

A

*The patient remains alert and is more comfortable and remains able to participate in the birth. (The mother is fully awake and part of the birth process)
*Promotes relaxation and good relaxation is achieved.
*Airway reflexes remain intact.
*Motor paralysis is mild.
*Gastric emptying is not delayed.

Benefit exists for women with DYSTOCIA (delayed or arrested
progress in labour, irrespective of causes) and who require
augmentation

46
Q

Because Opioids readily cross the placenta, what kind of effects can they have on fetus/new born?

A

Effects on the fetus and the newborn can be profound, including absent or minimal FHR variability during labour and significant newborn respiratory depression requiring treatment after birth, which may interfere with breastfeeding.

47
Q

What are patients who have continuous support beginning in early labour less likey to use and more likey to have?

A

-Less likely to use pain medications and epidurals

-More likely to have a spontaneous vaginal birth and less likely to report dissatisfaction with their birth experience (Good labour support also improves important health outcomes)

48
Q

Is there evidence that low-risk patients in labour that are allowed to eat have an increase obstetrical risk?

A

There is also evidence that allowing low-risk patients to eat during labour may shorten the length of labour and it does not increase obstetrical risk.

49
Q

Should patients in labour eat food? Why?
What about clear liquids?

A

patients should not eat solid foods once they are in established labour because of the delayed gastric emptying of solids.

Clear liquids, on the other hand, are emptied relatively quickly from the stomach and absorbed in the proximal small bowel.

50
Q

When should a labouring patient inhale nitrous oxide? Why?

A

The maximum therapeutic effect occurs approximately 50 seconds after continuous inhalation is commenced; therefore, beginning the inhalation process 30 seconds before the onset of a contraction (if regular) or as soon as a contraction begins (if irregular) provides the best pain relief.

51
Q

What is Pruritus?

A

Pruritus (itching) is an adverse effect that often occurs with epidural or spinal use of an opioid, especially fentanyl and morphine.

52
Q

Examples of cognitive strategies that can be used as pain relief during labour?

A

Childbirth education
Relaxation
Hypnosis
Biofeedback

53
Q

Is hot or cold application more effective for back pain during labour?

A

Cold because cooling relives pain by lowering the muscle temperature and reliving muscle spasms

54
Q

What physical factors can affect pain intensity during labour?

A

Physical factors that affect pain intensity include a scarred cervix, fatigue, the interval and duration of contractions, fetal size and position, rapidity of fetal descent, and maternal position

55
Q

What can cultural influences impose on how a women in labour percives pain?

A

Cultural influences may impose certain behavioural expectations regarding acceptable and unacceptable behaviour when one experiences pain.

56
Q

Where is visceral pain felt during labour?

A

. Visceral pain is felt over the lower portion of the abdomen.

57
Q

What is the most commonly used and effective pharmacological pain - relief method for labour pain?

A

Epidural anaesthesia and analgesia is the most effective pharmacological pain-relief method for labour that is available. As a result, it is the most commonly used method for relieving pain during labour in Canada

58
Q

What are the main advantages of Nitrous oxide? What are some other advantages?

A

Main ones are it is safe for both labouring patient and fetus and does not affect uterine activity.

Other Advantages are: Rapid onset of action, quick clearance through exhalation without accumulation in the labouring patient or fetal tissues, and the fact that the patient can self-administer the gas while remaining awake, alert, and completely able to function.

59
Q

Can past experiences of pain can affect subsequent pregnancies in either positive or negative ways?

A

Yes they can

60
Q

With an epidural, the combination of what agents preserves a greater degree of motor function?

A

The combination of an opioid with the local anaesthetic agent reduces the dose of anaesthetic required, thereby preserving a greater degree of motor function.

61
Q

What does the “Gate-Control” theory of pain help explain?

A

The gate-control theory of pain helps explain the way that some pain-relief techniques taught in childbirth preparation classes work to relieve the pain of labour.

62
Q

Examples of maternal ambulation and position change as a non-pharmacological comfort measure in early labour

A

Upright & gravity enhancing positions

Rhythmic motion

Change position frequently (every 30 - 60min)

63
Q

What determines a patients satisfaction with a childbirth experience?

A

It is determined by how well their personal expectations of child birth were met and the quality of support and interaction they received from caregivers

64
Q

What does “Effleurage” mean?

A

It is a non-pharmacological pain intervention that involves the light stroking, usually of the abdomen in rhythm with breathing during contractions

65
Q

What can hypotension from a epidural result in?

A

Hypotension can result in a significant decrease in uteroplacental perfusion and oxygen delivery to the fetus.

66
Q

Side effects of Opioid agonist analgesics during labour?

A

decreases uterine contractions, N&V, respiratory depression, maternal and neonatal CNS depression

67
Q
A
68
Q

What is counterpressure? How does it help labour?

A

Non-pharmalogical pain management strategy that is used during labour and involves steady pressure by a support system to the sacral area with a firm object (tennis ball) or the fist or heel of hand

It helps the labouring patient cope with the sensations of internal pressure and pain in the lower back especially during back labour

69
Q

When are epidurals typically started?

A

Usually started after labour is well established; otherwise may prolong labour

70
Q

What kind of pharmalogical pain managament can a labouring patient have for a caesaren birth labour?

A

Spinal (block) anaesthesia
Epidural (block) anaesthesia
General anaesthesia

71
Q

Who can insert an epidural?

A

Only qualified care providers (a physician in Canada) are permitted to insert a catheter and initiate epidural anaesthesia, verify catheter placement, and inject medication through the catheter.

72
Q

What are the main adverse effects of Nitrous Oxide?

A

The main adverse effects of nitrous oxide are nausea and dizziness

73
Q

Examples of common Opioid (narcotic) agonist that are used during labour?

A

Fentanyl, sufentanyl, morphine

74
Q

What is one of the main things that epidurals interfere with?

A

May interfere with mobility, e.g. walking during the 1st stage of labour

75
Q

A relationship between epidurals and (blank) have been documented (4 things)

A

A relationship between epidural analgesia and:
1.) longer second-stage of labour
2.) increased incidence of fetal malposition,
3.) use of oxytocin, and
4.) forceps- or vacuum-assisted birth

have also been documented

76
Q

When is sensory pain greater for multiparous patients? Why?

A

during the active phase of the first stage of labour and during the second stage of labour, multiparous patients may experience greater sensory pain than nulliparous patients because their more supple tissue increases the speed of fetal descent and thereby intensifies discomfort

77
Q

What are some disadvantages of an epidural?

A

1.) Hypotension
2.) Fever
3.) Urinary retention
4.) Prurirus
5.) Limited movement
6.) Longer second stage about
7.) Increased use of oxytocin
8.) Increased likelihood of forceps - or - vacuum- assisted birth

78
Q

How does hydrotherapy reduce pain during labour?

A

Water/tub must be full enough to completely cover the labouring mothers abdomen

-The water increases buoyancy and provides a scene of weightlessness and freedom of movement

79
Q

What does the fimmer tissue of nulliparous patients results in?

A

a slower, more gradual descent.

80
Q

What happens to the mothers MSK system in response to pain during labour?

A

Decreased oxygen supply to muscles increase pain

NURS 372 (Midterm) (8 decks)

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