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NURS787 Exam 2 > Comfort and Pain In Labor > Flashcards

Comfort and Pain In Labor Flashcards

1
Q

What are the 2 types of pain?

A

1) somatic –> deep or superficial

2) visceral = caused by ischemia or inflammation

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2
Q

What are the 2 types of nociceptors?

A

1) a-delta fibers = myelinated –> fast

2) c-fibers = unmyelinated –> slow

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3
Q

What stimuli are activated during labor?

A

1) mechanical from uterine stretching

2) chemical (e.g. glutamate, bradykinin, acetylcholine)

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4
Q

What are the 2 pathways via which pain travels to the brain in the first stage of labor?

A

1) neospinothalamic tract

2) paleospinothalamic tract

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5
Q

How is pain transmitted in the first stage of labor?

A

pain fibers of contracting uterus insert at spinal nerves T10-L1

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6
Q

What is the effect of increased catecholamines during pain response?

A

1) slow GI and GU motility
2) alter coagulation
3) alter immune responses

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7
Q

What effect does epinephrine have on labor?

A

is a tocolytic

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8
Q

What causes pain during contractions?

A

1) distension of uterine tissues

2) dilation of cervix

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9
Q

How is pain transmitted in the second stage of labor?

A

pain fibers inserting at S2 to S4

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10
Q

What causes pain in the second stage of labor?

A

distension of:

1) vagina
2) perineum
3) pelvic floor

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11
Q

What are the 2 pathways via which pain travels to the brain in the second stage of labor?

A

pudendal nerves

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12
Q

true or false:

pain relief is more important to birth satisfaction than the ability to cope with pain

A

false

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13
Q

According to Kolcaba, what is the first dimension of comfort?

A

the technical senses

1) relief - comfort need is met/there is a return to normal functioning
2) ease - state of calmness or contentment; required for effective performance
3) transcendence - state of feeling self-motivated to overcome problems

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14
Q

According to Kolcaba, what is the second dimension of comfort?

A

the contexts of experience

1) physical
2) sociocultural
3) psychospiritual
4) environmental

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15
Q

Describe the gate theory of pain

A

method of modulating pain

  • stimulate A-delta fibers
  • impulses rapidly traverse to dorsal horn –> “close a gate”
  • slower C-fiber impulses blocked –> cannot transmit deeper pain signals
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16
Q

Describe the neuromatrix theory of pain

A

pain = dynamic; 3 components:

1) physical
2) psychological
3) behavioral

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17
Q

What is the “talking down” method?

A

helps laboring person maintain sense of control and decrease pain

1) get person’s attention
2) position self close to person’s face
3) talk in a low voice so person is quiet to hear

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18
Q

What are factors that influence a birthing person’s response to labor?

A
  • psychological preparation
  • expectations
  • psst experiences of pain
  • fear of childbirth
  • emotional support during labor
  • culture
  • genetics
  • hx dysmenorrhea
  • nighttime (more pain)
  • unfamiliar setting
  • lack of self-efficacy
19
Q

When should pregnant people be counseled on pain management during labor?

A

during pregnancy

20
Q

What does continuous support in labor mean?

A

one support person who provides care to one laboring person and is physically present t/o labor

21
Q

Who provides the most effective continuous labor support?

A

trained doulas

vs relatives, partners, nurses, etc

22
Q

What is hydrotherapy?

A

the use of water for pain relief and relaxation during childbirth

23
Q

What is the mechanism by which hydrotherapy works?

A

increase in hydrostatic pressure + shift of extracellular fluid into circulation –> central blood volume bolus –> increases cardiac output –> decreases catecholamine levels

24
Q

When should hydrotherapy be utilized?

A

during active labor

water immersion in latent stage –> longer labor

25
Q

What is acupuncture?

A

needling of specific points along meridian pathway –> promotes blood circulation –> stimulates flow of Qi

26
Q

What is the mechanism by which acupuncture works?

A
  • stimulates production of endogenous opioids (endorphins)

- secretes neurotransmitters that maintain normal physiology and provide comfort

27
Q

What is acupressure?

A

applying firm, steady pressure to acupoints using thumb and finger

28
Q

Describe acupoint “spleen 6”

A
  • four finger breadths above malleolus, along tibia - should be a tender point
  • labor augmentation
  • encourage efficient labor
  • reduce cervical lip
  • reduction of labor pain
  • reduction of length of labor
29
Q

Describe acupoint “large intestine 4”

A
  • highest place on metacarpal bone on radial aspect (b/w thumb and index finger)
  • reduces labor pain
  • promotes stronger and/or more coordinated contractions
30
Q

Describe acupoint “bladder 32”

A
  • place 4 fingertips on point b/w lumbar vertebra and sacral crest –> slide fingers over until slight depression = sacral foramen - aim for middle finger being in second sacral foramen
  • basically it’s a little divot in between the spine and yer buttcheek
  • reduction of labor pain
  • induction of labor
31
Q

Describe acupoint “gallbladder 21”

A
  • on shoulder, directly above nipple; palpate deeply for most tender spot
  • facilitates fetal descent in active phase and second stage
32
Q

Describe acupoint “bladder 60”

A
  • depression b/w lateral malleolus and Achilles tendon

- relieves lower back pain

33
Q

Describe acupoint “bladder 67”

A
  • dorsum of pinky toe, kind of at base of nail
  • version of breech to cephalic presentation
  • with LI4, used to reduce labor pain
  • stimulates uterine contractions
34
Q

Describe acupoint “liver 3”

A
  • in hollow b/w metacarpals of first and second toes
  • softens cervix
  • reduces labor pain
35
Q

Describe acupoint “stomach 36”

A
  • 4 finger breadths below kneecap w/ leg flexed + 1 finger breadth lateral to tibial crest
  • relief of maternal exhaustion
  • relief of N/V, hiccups, belching
36
Q

What are contraindications to acupuncture/pressure?

A

1) fetal intolerance to labor
2) uterine tachysystole
3) tetanic contractions
4) preterm gestation
5) other conditions where contractions are contraindicated (e.g. placenta previa)

37
Q

What are sterile water papules?

A

intradermal injections of sterile water in lower lumbosacral area to relieve back pain

38
Q

What is the mechanism by which sterile water papules work?

A

distension of skin –> noxious stimulation of nociceptors and mechanoreceptors –> release of endorphins + stimulation of A delta fibers (gate theory)

39
Q

How long do sterile water papules work?

A

45mins to 3h

40
Q

What is hynosis?

A

mind-body techniques to induce profound relaxation w/in state of focused attention

41
Q

When is hypnosis most effective?

A

during prenatal stage

42
Q

When is hypnosis contraindicated?

A

1) hx of psychosis

2) severe mental health condition

43
Q

Which scents are most commonly used for pain relief?

A

1) lavender

2) frankincense

NURS787 Exam 2 (8 decks)

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