Exam 2: Labor Pain Management

Question 1

Non-pharmacologic pain management

Answer 1

Continuous labor support
Hydrotherapy
Ambulation and position changes
Acupuncture and acupressure
Attention focusing and imagery
Therapeutic touch and massage (effleurage)
TENS
Breathing techniques

Question 2

Pharmacologic pain management

Answer 2

Opioids (butorphanol, nalbuphine, morphine, fentanyl)
Antiemetics (hydroxyzine)
Nitrous oxide (inhalant)
Normal saline injections (in back)

Question 3

Why would you not give opioids?

Answer 3

If delivery is anticipated within 2 hours (respiratory depression)
Contraindicated for anyone with history of opioid abuse

Question 4

Epidural block

Answer 4

Continuous infusion or intermittent injection
Usually started when in active labor
Combined spinal-epidural block (walking epidural)
Nursing intervention:
Administer a bolus of IV fluids to help offset maternal hypotension (within 15-30 minutes of the catheter placement)
Assess for orthostatic hypotension (be prepared to administer an IV vasopressor, position the client laterally, increase the rate of IV fluid administration, and initiate oxygen)

Question 5

Pudendal Block

Answer 5

Local anesthetic administered transvaginally into the space in front of the pudendal nerve
Used for 2nd stage episiotomy or operative vaginal birth
Adverse effect: Compromise of maternal bearing down reflect

Question 6

Intrathecal (spinal) anesthesia block

Answer 6

Local anesthetic injected into the subarachnoid space into the spinal fluid at the 3rd, 4th, or 5th lumbar interspace. Used during labor and cesarean birth

Question 7

Nursing management after epidural placement

Answer 7

Assess blood pressure, pulse, respirations, pulse ox
Assess bladder every 2 hours and empty bladder every 2-4 hours
FHR assessment
Education of effects of anesthesia and pain/pressure

Question 8

Why do you regularly assess the bladder of a PT after they have an epidural?

Answer 8

Full bladder could prevent fetus from descending

Question 9

General anesthesia

Answer 9

Rarely used for vaginal or cesarean births when there are no complications present. Only used when a delivery complication or emergency when there is a contraindication to nerve block anesthesia.
Baby must be delivered within minutes, do not want baby to have respiratory depression
Nursing interventions:
Assess client postpartum for decreased uterine tone which can lead to hemorrhage and be produced by pharmacological agents used in general anesthesia
Facilitate parent-newborn attachment ASAP