Chapter 17: Maximizing Comfort for the Laboring Woman

Question 1

_______ describes the discomfort felt during the first stage of labor

Answer 1

Visceral pain

Question 2

_______ pain and is related to the changes in the cervix, uterine ischemia, and distention of the lower uterine segment

Answer 2

Visceral pain

Question 3

_______ is often described as a dull aching pain

Answer 3

visceral pain

Question 4

_______ describes pain that originates in the uterus and radiates to the abdominal wall, the lumbosacral area of the back, iliac crest, gluteus maximus, and down the thighs

Answer 4

referred pain

Question 5

________ is fast, localized, intense, sharp, burning, prickling pain

Answer 5

somatic pain

Question 6

________ pain occurs usually during the second stage of labor

Answer 6

somatic

Question 7

_________ pain is associated with the stretching and distention of the perineal body

Answer 7

somatic

Question 8

during labor, the sympathetic nervous system responds to pain with increased levels of_________

Answer 8

catecholamines (epinephrine and norepinephrine)

Question 9

increased maternal oxygen consumption results in________

Answer 9

respiratory alkalosis

Question 10

if there is a history of dysmenorrhea, increased childbirth pain might be r/t __________

Answer 10

higher levels of circulating prostaglandins

Question 11

_______ are endogenous opioids secreted by the pituitary gland and produce analgesia

Answer 11

endorphins

Question 12

maternal anxiety during labor triggers the release of ________

Answer 12

catecholamines

Question 13

________ increase the amount of pelvic pain stimuli sent to the brain which causes an intensified perception of pain

Answer 13

catecholamines

Question 14

during early labor when the woman can no longer walk or talk through contractions she might want to start _________ breathing

Answer 14

slow paced

Question 15

breathing techniques always start and end with _______

Answer 15

slow, deep, cleansing breath

Question 16

_______ is a breathing pattern in which the woman begins to breathe slowly in and out of her mouth while the support person counts out loud

Answer 16

slow paced breathing

Question 17

during slow paced breathing, the woman should take ________ breaths per minute

Answer 17

6-8

Question 18

the breathing count for slow paced breathing is:

Answer 18

inhale 1, 2, 3, 4

exhale 1, 2, 3, 4

Question 19

as labor progresses and the contractions increase in intensity and frequency, the patient may need to switch to ________ breathing

Answer 19

modified-paced breathing

Question 20

during this breathing techniques, breaths are shallow and at a rate of 32-40 breaths per minute

Answer 20

modified- paced breathing

Question 21

during this breathing technique the woman inhales slowly and exhales fast

Answer 21

modified-paced breathing

Question 22

when should patients use the pattern paced breathing

Answer 22

during the transition phase when contractions are most intense

Question 23

what is pattern paced breathing

Answer 23

inhale/ exhale three or four times and then exhale with pursed lips on the last breath

Question 24

_______ is a gentle stroking technique performed in rhythm with contractions

Answer 24

effleurage

Question 25

with the ________ technique, the support person massaged mommy's belly in circular motions

Answer 25

effleurage

Question 26

________ is a pain relief technique in which the support person uses their fist or heel of the hand to apply steady pressure to the sacral area

Answer 26

counterpressure

Question 27

________ pain relief technique is especially useful when maternal back pain results from the fetus occiput is pressing against the sacral nerves

Answer 27

counterpressure

Question 28

_______ is based on the use of the body's prana (energy fields)

Answer 28

therapeutic touch

Question 29

_______ is based on the body's energy fields and employs a combination of techniques from multiple disciplines

Answer 29

healing touch

Question 30

_______ is the use of warm water to promote comfort and relaxation

Answer 30

hydrotherapy

Question 31

immersion in a hot tub during labor decreases the production of maternal ________ which prompts an increase in _______ and _______

Answer 31

catecholamines; oxytocin; endorphins

Question 32

when the fetus is in transverse or occiput posterior position, these two positions provide comfort and help facilitate fetal rotation

Answer 32

side lying and hands and knees position

Question 33

_______ is a structured technique that enables the patient to achieve a state of heightened awareness and focused concentration that can be used to alter their perception of pain

Answer 33

hypnosis

Question 34

________ is the use of essential oils derived from plants, flowers, herbs, and trees whose aroma is thought to have healing effects

Answer 34

aromatherapy

Question 35

``` four fragrances thought to promote comfort and relaxation and reduce pain: 1. 2. 3. 4. ```

Answer 35

1. rose 2. lavender 3. frankincense 4. bergamot

Question 36

the application of _______ and ________ should be used alternately to enhance their effects

Answer 36

hot; cold

Question 37

_______ exerts therapeutic effect by relieving muscle ischemia and increasing blood flow to the area of discomfort

Answer 37

heat

Question 38

application of ________ to the perineum helps with pain associated with scratching and can prevent tearing during the second stage of labor

Answer 38

heat

Question 39

_________ exert therapeutic effect by reducing muscle temperature and relieving muscle spasms

Answer 39

cold packs

Question 40

________ involves the delivery of an electric current through electrodes that are applied to the skin over the painful region of a peripheral nerve

Answer 40

transcutaneous electrical nerve stimulation (TENS)

Question 41

________ is a technique in which a small needle injects small amounts of water into four locations on the patient's lower back to relieve back pain

Answer 41

intradermal water block

Question 42

how much sterile water is used in an intradermal water block

Answer 42

.005- .01 mL

Question 43

where are the four locations for intradermal water block

Answer 43

two over the posterior iliac spine and two 3 cm below and 1 cm medially to the first two

Question 44

in order for mommy to receive _______ uterine contractions should be consistent

Answer 44

analgesics

Question 45

______ are commonly used in labor, but they can cross the placenta and cause neonatal respiratory distress

Answer 45

opioids

Question 46

_______ are agents used to relieve anxiety and induce sleep

Answer 46

sedatives

Question 47

sedatives are typically used for women who:

Answer 47

are in a prolonged latent phase and pain and anxiety need to be reduced

Question 48

common opioids used during labor include:

Answer 48

1. fentanyl 2. nubain (nalbuphine) 3. morphine 4. Stadol (butorphanol)

Question 49

__________ is the the alleviation of the sensation of pain or the raising of the threshold for pain perception without loss of consciousness

Answer 49

analgesia

Question 50

benzodiazepine antagonist:

Answer 50

Flumazenil

Question 51

hydromorphone hydrochloride, meperidine hydrochloride, fentanyl citrate, and sufentanil are all examples of:

Answer 51

Opioid Agonist Analgesics

Question 52

opioid analgesia should be given:

Answer 52

either less than one hour or grater than four hours before birth to minimize neonatal depression

Question 53

butorphanol and nalbuphine are examples of:

Answer 53

opioid agonist-antagonist analgesics

Question 54

_________ is used to provide pain control when an episiotomy is performed or if sutures are necessary in the perineum

Answer 54

local perineal infiltration anesthesia

Question 55

_______ is a nerve block that provides pain relief in the lower vagina, vulva, and perineum

Answer 55

pudendal nerve block

Question 56

when should a pudendal nerve block be administered

Answer 56

10-20 minutes before perineal anesthesia is needed- usually late in the second stage of labor when an episiotomy is necessary

Question 57

__________ is an injection of a solution containing a local anesthetic combined with fentanyl through the third, fourth, or fifth lumbar space to the subarachnoid space

Answer 57

spinal anesthesia block

Question 58

most common complication of a spinal anesthesia block

Answer 58

hypotension

Question 59

_________ is a complication hat can occur within 48 hours after a spinal puncture and is believed to occur from a leakage of CSF

Answer 59

post-dural puncture headache

Question 60

a post-dural puncture headache characteristically gets worse when:

Answer 60

the patient sits up

Question 61

treatment of a post-dural puncture headache includes:

Answer 61

oral analgesics, bedrest in a dark room, caffeine, and hydration

Question 62

epidural blood patch

Answer 62

10-20 mL of the patient's blood is slowly injected into the lumbar epidural space and forms a clot so no more CSF leaks

Question 63

the most effective pharmacologic pain relief in labor is:

Answer 63

epidural anesthesia or analgesia block

Question 64

________ is the injection of a local anesthetic or an opioid (or both) into the epidural space

Answer 64

epidural anesthesia or analgesia block

Question 65

________ is the most commonly used method of pain control during labor

Answer 65

lumbar epidural and block

Question 66

how to prevent hypotension from an epidural

Answer 66

preloading the patient with a rapid infusion of IV fluids

Question 67

an accidental injection of a local anesthetic into a blood vessel can cause

Answer 67

CNS effects: weird behavior, disorientation, excitation

Question 68

for relief of pain during a vaginal delivery, a block from ______ to ______ is performed

Answer 68

T5; T10

Question 69

when is a block given for a vaginal birth

Answer 69

when cervix is dilate 5-6 cm

Question 70

for a caesarian birth a block from _____ to _____ is required

Answer 70

T8-S1

Question 71

a ________ is sometimes used to block pain transmission without interfering with motor ability

Answer 71

combined spinal-epidural analgesia aka walking epidural

Question 72

nitrous oxide can be mixed with oxygen and can be inhaled at _____ or less to provide analgesia during ______ and ______ stages of labor

Answer 72

50%; 1st; second

Question 73

where does local perineal infiltration work

Answer 73

perineum

Question 74

where does the pudendal nerve block work

Answer 74

perineum and lower vagina

Question 75

where is a spinal anesthesia block felt

Answer 75

uterus, cervix, vagina, and perineum

Question 76

where is a lumbar epidural block felt

Answer 76

uterus, cervix, vagina, and perineum

Question 77

where is a combined spinal-epidural felt

Answer 77

uterus, cervix, vagina, and perineum

Question 78

when can local perineal infiltration be administered

Answer 78

immediately before or after birth

Question 79

when can a pudendal nerve block be given

Answer 79

late in second stage for episiotomy, forceps or vacuum, and during third stage for repairs

Question 80

when can spinal anesthesia block be given

Answer 80

first stage for elective and emergent c-sections

Question 81

when is a combined spinal-epidural given?

Answer 81

spinal analgesics can be given during latent phase and then the epidural is given when active labor begins