Chapter 16 Management of Discomfort Flashcards Preview

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Flashcards in Chapter 16 Management of Discomfort Deck (38):
1

An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, “My contractions are so strong that I don’t know what to do.” The nurse should:
a. Assess for fetal well-being.
b. Encourage the woman to lie on her side.
c. Disturb the woman as little as possible.
d. Recognize that pain is personalized for each individual.





D
Each woman’s pain during childbirth is unique and is influenced by a variety of physiologic, psychosocial, and environmental factors. A critical issue for the nurse is how support can make a difference in the pain of the woman during labor and birth.
Assessing for fetal well-being includes no information that would indicate fetal distress or a logical reason to be overly concerned about the well-being of the fetus. The left lateral position is used to alleviate fetal distress, not maternal stress. The nurse has an obligation to provide physical, emotional, and psychosocial care and support to the laboring woman. This client clearly needs support.

2

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory?
a. Massaging the woman’s back
b. Changing the woman’s position
c. Giving the prescribed medication
d. Encouraging the woman to rest between contractions


A
According to the gate-control 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. Distraction techniques such as massage or stroking, music, focal points, and imagery reduce or completely block the capacity of nerve pathways to transmit pain. These distractions are thought to work by closing down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished. Changing the woman’s position, giving prescribed medication, and encouraging rest do not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.

3

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client’s blood pressure? Choose all that apply.
a. Place the woman in a supine position.
b. Place the woman in a lateral position.
c. Increase intravenous (IV) fluids.
d. Administer oxygen.
e. Perform a vaginal examination.



B, C, D
Nursing interventions for maternal hypotension arising from analgesia or anesthesia include turning the woman to a lateral position, increasing IV fluids, administering oxygen via face mask, elevating the woman’s legs, notifying the physician, administering an IV vasopressor, and monitoring the maternal and fetal status at least every 5 minutes until these are stable. Placing the client in a supine position would cause venous compression, thereby limiting blood flow to and oxygenation of the placenta and fetus. A sterile vaginal examination has no bearing on maternal blood pressure.

4

After change-of-shift report the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is:
a. Visceral. c. Somatic.
b. Referred. d. Afterpain.

B
As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

5

With regard to spinal and epidural (block) anesthesia, nurses should know that:
a. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births.
b. A high incidence of after-birth headache is seen with spinal blocks.
c. Epidural blocks allow the woman to move freely.
d. Spinal and epidural blocks are never used together.

B
Headaches may be prevented or mitigated to some degree by a number of methods. Spinal blocks may be used for vaginal births, but the woman must be assisted through labor. Epidural blocks limit the woman’s ability to move freely. Combined use of spinal and epidural blocks is becoming increasingly popular.

6

With regard to breathing techniques during labor, maternity nurses should be aware that:
a. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction.
b. By the time labor has begun, it is too late for instruction in breathing and relaxation.
c. Controlled breathing techniques are most difficult near the end of the second stage of labor.
d. The patterned-paced breathing technique can help prevent hyperventilation.

A
First-stage techniques promote relaxation of abdominal muscles, thereby increasing the size of the abdominal cavity. Instruction in simple breathing and relaxation techniques early in labor is possible and effective. Controlled breathing techniques are most difficult in the transition phase at the end of the first stage of labor when the cervix is dilated 8 to 10 cm. Patterned-paced breathing sometimes can lead to hyperventilation.

7

In assessing a woman for pain and discomfort management during labor, a nurse most likely would:
a. Have the woman use a visual analog scale (VAS) to determine her level of pain.
b. Note drowsiness as a sign that the medications were working.
c. Interpret a woman’s fist clenching as an indication that she is mad at her male partner and the physician.
d. Evaluate the woman’s skin turgor to see whether she needs a gentle oil massage.

A
The VAS is a means of adding the woman’s assessment of her pain to the nurse’s observations. Drowsiness is a side effect of medications, not usually (sedatives aside) a sign of effectiveness. The fist clenching likely is a sign of apprehension that may need attention. Skin turgor, along with the moistness of the membranes and the concentration of the urine, are signs that help the nurse evaluate hydration.

8

A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease?
a. Meperidine (Demerol)
b. Butorphanol tartrate (Stadol)
c. Promethazine (Phenergan)
d. Nalbuphine (Nubain)

A
Meperidine is the most commonly used opioid agonist analgesic for women in labor throughout the world. It overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, meperidine is used cautiously in women with cardiac disease. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of the undesirable effects of those drugs. Stadol and Nubain are opioid agonist-antagonist analgesics.

9

Today the pregnant woman has a number of nonpharmacologic measures available to her to assist with pain relief in labor. One such measure involves the application of heat, cold, or pressure to specific areas of the body and is known as ____________________.

Acupressure
The effectiveness of acupressure has been attributed to the gate-control theory of pain and an increase in endorphin levels. Pressure is applied to acupuncture points called tsubos. These points have an increased density of neuroreceptors and increased electrical conductivity. Pressure is initially applied with contractions and then continually as labor progresses.

10

With regard to nerve block analgesia and anesthesia, nurses should be aware that:
a. Most local agents are related chemically to cocaine and end in the suffix -caine.
b. Local perineal infiltration anesthesia is effective when epinephrine is added, but it can be injected only once.
c. A pudendal nerve block is designed to relieve the pain from uterine contractions.
d. A pudendal nerve block, if done correctly, does not significantly lessen the bearing-down reflex.

A
Common agents include lidocaine and chloroprocaine. Injections can be repeated to prolong the anesthesia. A pudendal nerve block relieves pain in the vagina, vulva, and perineum but not the pain from uterine contractions and it lessens or shuts down the bearing-down reflex.

11

A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens, and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to subside. When the inhalation stops, the valve closes. This procedure is:
a. Not used much anymore.
b. Likely to be used in the second stage of labor but not in the first stage.
c. An application of nitrous oxide.
d. A prelude to cesarean birth.

C
This is an application of nitrous oxide, which could be used in either the first or second stage of labor (or both) as part of the preparation for a vaginal birth.

12

With regard to systemic analgesics administered during labor, nurses should be aware that:
a. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier.
b. Effects on the fetus and newborn can include decreased alertness and delayed sucking.
c. Intramuscular administration (IM) is preferred over intravenous (IV) administration.
d. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B
Effects depend on the specific drug given, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCA results in decreased use of an analgesic.

13

Nurses should be aware of the differences experience can make in labor pain such as:
a. Sensory pain for nulliparous women often is greater than for multiparous women during early labor.
b. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor.
c. Women with a history of substance abuse experience more pain during labor.
d. Multiparous women have more fatigue from labor and therefore experience more pain.

A
Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

14

In the current practice of childbirth preparation, emphasis is placed on:
a. The Dick-Read (natural) childbirth method.
b. The Lamaze (psychoprophylactic) method.
c. The Bradley (husband-coached) method.
d. Getting expectant parents to attend childbirth preparation in any or no specific method.

D
Getting expectant parents to class is most important, because preparation increases a woman’s confidence and thus her ability to cope with labor and birth.

15

A laboring woman received meperidine (Demerol) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate?
a. Fentanyl (Sublimaze) c. Naloxone (Narcan)
b. Promethazine (Phenergan) d. Nalbuphine (Nubain)

C
An opioid antagonist can be given to the newborn as one part of the treatment for neonatal narcosis, which is a state of central nervous system (CNS) depression in the newborn produced by an opioid. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects, especially respiratory depression. Fentanyl, promethazine, and nalbuphine do not act as opioid antagonists to reduce the postnatal effects of Demerol on the neonate.

16

A woman in labor has just received an epidural block. The most important nursing intervention is to:
a. Limit parenteral fluids.
b. Monitor the fetus for possible tachycardia.
c. Monitor the maternal blood pressure for possible hypotension.
d. Monitor the maternal pulse for possible bradycardia.

C
The most important nursing intervention for a woman who has received an epidural block is to monitor the maternal blood pressure frequently for signs of hypotension. Intravenous fluids are increased for a woman receiving an epidural to prevent hypotension. The nurse observes for signs of fetal bradycardia. The nurse monitors for signs of maternal tachycardia secondary to hypotension.

17

The nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if:
a. The mother gives birth without any analgesic or anesthetic.
b. The mother and family’s priorities and preferences are incorporated into the plan.
c. The primary health care provider decides the best pain relief for the mother and family.
d. The nurse informs the family of all alternative methods of pain relief available in the hospital setting.

B
The assessment of the woman, her fetus, and her labor is a joint effort of the nurse and the primary health care providers, who consult with the woman about their findings and recommendations. The needs of each woman are different, and many factors must be considered before a decision is made whether pharmacologic methods, nonpharmacologic methods, or a combination of the two will be used to manage labor pain.

18

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should:
a. Notify the woman’s physician.
b. Tell the woman to slow the pace of her breathing.
c. Administer oxygen via a mask or nasal cannula.
d. Help her breathe into a paper bag

D
This woman is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.

19

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use:
a. Counterpressure against the sacrum.
b. Pant-blow (breaths and puffs) breathing techniques.
c. Effleurage.
d. Conscious relaxation or guided imagery.

A
Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. The pain management techniques of pant-blow, effleurage, and conscious relaxation or guided imagery are usually helpful for contraction per the gate-control theory.

20

If an opioid antagonist is administered to a laboring woman, she should be told that:
a. Her pain will decrease.
b. Her pain will return.
c. She will feel less anxious.
d. She will no longer feel the urge to push.



B
The woman should be told that the pain that was relieved by the opioid analgesic will return with administration of the opioid antagonist. Opioid antagonists, such as Narcan, promptly reverse the central nervous system (CNS) depressant effects of opioids. In addition, the antagonist counters the effect of the stress-induced levels of endorphins. An opioid antagonist is especially valuable if labor is more rapid than expected and birth is anticipated when the opioid is at its peak effect.

21

Maternity nurses often have to answer questions about the many, sometimes unusual ways people have tried to make the birthing experience more comfortable. For instance, nurses should be aware that:
a. Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine.
b. Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time.
c. Effleurage is permissible, but counterpressure is almost always counterproductive.
d. Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

D
Transcutaneous electrical nerve stimulation does help. Music may be very helpful for reducing tension and certainly can be accommodated by the hospital. Women can stay in a bath as long as they want, although repeated baths with breaks might be more effective than a long soak. Counterpressure can help the woman cope with lower back pain.

22

With regard to a pregnant woman’s anxiety and pain experience, nurses should be aware that:
a. Even mild anxiety must be treated.
b. Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.
c. Anxiety may increase the perception of pain, but it does not affect the mechanism of labor.
d. Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

B
Anxiety and pain reinforce each other in a bad cycle. Mild anxiety is normal for a woman in labor and likely needs no special treatment other than the standard reassurances. Anxiety increases muscle tension and ultimately can build sufficiently to slow the progress of labor. Unfortunately an anxious, painful first labor is likely to carry over, through expectations and memories, into an anxious and painful experience in the second pregnancy.

23

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help clients. Nurses should know that _____ women may be stoic until late in labor, when they may become vocal and request pain relief.
a. Chinese c. Hispanic
b. Arab or Middle Eastern d. African-American

C
Hispanic women may be stoic early, more vocal and ready for medications later. Chinese women may not show reactions to pain. Medical interventions must be offered more than once. Arab or Middle Eastern women may be vocal in response to labor pain from the start. They may prefer pain medications. African-American women may express pain openly; use of medications for pain is more likely to vary with the individual.

24

Which statement correctly describes the effects of various pain factors?
a. Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth.
b. Upright positions in labor increase the pain factor because they cause greater fatigue.
c. Women who move around trying different positions are experiencing more pain.
d. Levels of pain-mitigating -endorphins are higher during a spontaneous, natural childbirth.

D
Higher endorphin levels help women tolerate pain and reduce anxiety and irritability. Higher prostaglandin levels correspond to more severe labor pains. Upright positions in labor usually result in improved comfort and less pain. Moving freely to find more comfortable positions is important for reducing pain and muscle tension.

25

To help clients manage discomfort and pain during labor, nurses should be aware that:
a. The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
b. Referred pain is the extreme discomfort between contractions.
c. The somatic pain of the second stage of labor is more generalized and related to fatigue.
d. Pain during the third stage is a somewhat milder version of the second stage.

A
This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, and gluteal area. Second-stage labor pain is intense, sharp, burning, and localized. Third-stage labor pain is similar to that of the first stage.

26

A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because:
a. “The two together work the best for you and your baby.”
b. “Sedatives help the opioid work better, and they also will help relax you and relieve your nausea.”
c. “They work better together so you can sleep until you have the baby.”
d. “This is what the doctor has ordered for you.”

B
Sedatives can be used to reduce the nausea and vomiting that often accompany opioid use. In addition, some ataractics reduce anxiety and apprehension and potentiate the opioid analgesic affects. A potentiator may cause the two drugs to work together more effectively, but it does not ensure maternal or fetal complications. Sedation may be a related effect of some ataractics, but it is not the goal. Furthermore, a woman is unlikely to be able to sleep through transitional labor and birth. “This is what the doctor has ordered for you” may be true, but it is not an acceptable comment for the nurse to make.

27

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman’s intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman’s hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman?
a. She is too far dilated.
b. She has thrombocytopenia.
c. She is anemic.
d. She is septic.

B
The platelet count indicates thrombocytopenia (low platelets), which is a contraindication to epidural analgesia/anesthesia. Typically epidural analgesia/anesthesia is used in the laboring woman when a regular labor pattern has been achieved, as evidenced by progressive cervical change. The laboratory values show that the woman’s hemoglobin and hematocrit are in the normal range and show a slight increase in the WBC count; not uncommon in laboring women.

28

The role of the nurse with regard to informed consent is to:
a. Inform the client about the procedure and have her sign the consent form.
b. Act as a client advocate and help clarify the procedure and the options.
c. Call the physician to see the client.
d. Witness the signing of the consent form.

B
Nurses play a part in the informed consent process by clarifying and describing procedures or by acting as the woman’s advocate and asking the primary health care provider for further explanations. The physician is responsible for informing the woman of her options, explaining the procedure, and advising the client about potential risk factors. The physician must be present to explain the procedure to the client. However, the nurse’s responsibilities go further than simply asking the physician to see the client. The nurse may witness the signing of the consent form. However, depending on the state’s guidelines, the woman’s husband or another hospital health care employee may sign as witness.

29

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse’s immediate response would be to:

A. encourage the woman to breathe more slowly.
B. help the woman breathe into a paper bag.
C. turn the woman on her side.
D. administer a sedative.






B.
Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression since this woman, being in the transition phase, is near the birth process. The side-lying position would be appropriate for supine hypotension.






















30

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman’s blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

A. Encourage her to empty her bladder.
B. Decrease her intravenous (IV) rate to a keep vein-open rate.
C. Turn the woman to the left lateral position or place a pillow under her hip. Correct
D. No action is necessary since a decrease in the woman’s blood pressure is expected.

C.

Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor’s or nurse midwife’s instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.

31

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse’s MOST appropriate analgesic for pain control is:

A. fentanyl (Sublimaze).
B. promethazine (Phenergan).
C. butorphanol tartrate (Stadol).
D. nalbuphine (Nubain).


A.

Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs’ undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

32

After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient’s plan of care? (Select all that apply.)

A. Keeping the head of bed elevated at all times
B. Administration of oral analgesics
C. Avoid caffeine
D. Assisting with a blood patch procedure
E. Frequent monitoring of vital signs

B D E

The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012). Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

33

When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? (Select all that apply.)

A. Maternal blood pressure of 108/79
B. Maternal heart rate of 98
C. Respiratory rate of 14 breaths/min
D. Fetal heart rate of 100 beats/min
E. Minimal variability on a fetal heart monitor

D E
After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

34

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is:

A. visceral.
B. referred.
C. somatic.
D. afterpain.


B.

Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

35

With regard to systemic analgesics administered during labor, nurses should be aware that:

A. systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier.
B. effects on the fetus and newborn can include decreased alertness and delayed sucking.
C. IM administration is preferred over IV administration.
D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B.

Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

36

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that:

A. either hot or cold applications may provide relief, but they should never be used together in the same treatment.
B. acupuncture can be performed by a skilled nurse with just a little training.
C. hand and foot massage may be especially relaxing in advanced labor when a woman’s tolerance for touch is limited.
D. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

C.
Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

37

A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use:

A. counterpressure against the sacrum.
B. pant-blow (breaths and puffs) breathing techniques.
C. effleurage.
D. biofeedback.



A

Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain; however, it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support.

38

Nurses should be aware of the difference experience can make in labor pain, such as:

A. sensory pain for nulliparous women often is greater than for multiparous women during early labor.
B. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor.
C. women with a history of substance abuse experience more pain during labor.
D. multiparous women have more fatigue from labor and therefore experience more pain.

A

Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.