L&D/Pain Management 1/Pain Assessment & Nonpharmacological methods

Question 1

First Stage of Labor
Sources of pain during the stages of labor
Describe
Caused by (3)

Pain Assessment

Answer 1

First stage – labor pain is an internal visceral pain that may be felt as back and leg
pain, which is caused by:
■ Dilation, effacement, and stretching of the cervix.
■ Distention of the lower segment of the uterus.
■ Contractions of the uterus with resultant uterine ischemia.

Question 2

Second Stage of Labor
Sources of pain during the stages of labor
Describe
Caused by (3)

Pain Assessment

Answer 2

Second stage – labor pain that is somatic and occurs with fetal descent and expulsion.
Pain is caused by:
■ Pressure and distention of the vagina and the perineum, described by the client
as “burning, splitting, and tearing.”
■ Pressure and pulling on the pelvic structures (ligaments, fallopian tubes, ovaries,
bladder, and peritoneum).
■ Lacerations of soft tissues (cervix, vagina, and perineum)

Question 3

Third Stage of Labor
Sources of pain during the stages of labor
Describe
Caused by (2)

Pain Assessment

Answer 3

Third stage – labor pain with the expelling of the placenta is similar to the pain
experienced during the first stage. Pain is caused by:
■ Uterine contractions.
■ Pressure and pulling of pelvic structures.

Question 4

Fourth Stage of Labor
Sources of pain during the stages of labor
Caused by (2)

Pain Assessment

Answer 4

Fourth stage – pain is caused by:
■ Distention and stretching of the vagina and perineum incurred during the second
stage with a splitting, burning, and tearing sensation.
● Safety for the mother and fetus must be the first consideration of the nurse when planning
pain management measures.

Question 5

Nursing PRIORITY when planning pain management measures.

Pain Assessment

Answer 5

Safety for the mother and fetus must be the first consideration of the nurse when planning
pain management measures.

Question 6

Pain level cannot always be assessed by monitoring the outward expressions of a client’s pain.

Pain Assessment (2)

Answer 6

Pain level cannot always be assessed by monitoring the outward expressions of a client’s pain.
1) Client pain assessment may require persistent questioning and astute observation by
the nurse.
2) Cultural beliefs and behaviors of women during labor and delivery can affect the
client’s pain management.

Question 7

Anxiety

Pain Assessment: “Cycle” (3)

Answer 7

Anxiety
■ Anxiety and fear are associated with pain. As fear and anxiety increase, muscle
tension increases, and thus the experience of pain increases. This can become an
increasing cycle of pain. The fear, tension, and pain cycle is illustrated below.

Question 8

Fear-Tension-Pain Cycle
An increase cycle of pain

Pain Assessment

Answer 8

Fear
☐ Fatigue
☐ Full bladder
☐ Individual pain tolerance
☐ Previous experiences with pain
☐ Fetal malposition
☐ Cephalopelvic disproportion
☐ Childbirth preparation
☐ Level of support during labor

Question 9

Assess the beliefs and expectations related to

Pain Assessment

Answer 9

Assess the beliefs and expectations related to discomfort, pain relief, and birth plans regarding pain relief methods for a client who is in labor.

Question 10

Factors assessed to evaluate pain (6)

Pain Assessment

Answer 10

● Assess the client’s level, quality, frequency, duration, intensity, and location of pain
through verbal and nonverbal cues. Use an appropriate pain scale allowing the client to
indicate on a scale from 0 to 10 the severity of her pain with 10 representing the most
severe pain.

Question 11

Signs and symptoms of pain (2)

Pain Assessment

Answer 11

Signs and symptoms of pain
■ Behavioral manifestations such as crying, moaning, screaming, gesturing,
writhing, avoidance or withdrawal, and inability to follow instructions
■ Increasing blood pressure, tachycardia, and hyperventilation

Question 12

A nurse is responsible for helping the client
Maintain?
Administer?
When?

Pain Assessment

Answer 12

A nurse is responsible for helping the client maintain the proper position during
administration of pharmacological interventions. She is also responsible for assisting the
client with positioning for comfort after pharmacological administration during labor and
birth.

Question 13

A nurse should provide client safety after the administration of any pharmacological intervention by (4)

Pain Assessment

Answer 13

A nurse should provide client safety after the administration of any pharmacological
intervention by putting the bed in a low position, maintaining side rails in the up position,
placing the call light within the client’s reach, and advising the client and her partner to
call for assistance if she needs to leave the bed or ambulate.

Question 14

How to evaluate pt response to pain relief?

Pain Assessment

Answer 14

Evaluate the client’s response to pain relief methods used (verbal report that pain is relieved
or being relieved, appears relaxed between contractions).

Question 15

First Stage: Latent (2)

Timing and Effectiveness of Pain Relief during Labor

Answer 15

Sedative followed by spinal block adm during 2nd Stagecovers til end of3rd Stage
Nonpharmacological methods

Question 16

First Stage: Active

Timing and Effectiveness of Pain Relief during Labor

Answer 16

Opioid
Epidural - Adm Active phase covers til end of 3rd Stage
Nonpharmacological methods

Question 17

First Stage: Transition

Timing and Effectiveness of Pain Relief during Labor

Answer 17

Nonpharmacological methods

not adm but covered by Epidural adm during Active Phase

Question 18

Second Stage (4)
Timing and Effectiveness of Pain Relief during Labor

Answer 18

adm during 2nd Stage cover til end of 3rd Phase

1) Spinal block adm during 2nd Stage cover til end of 3rd Phase
2) Pudendal
3) Local Infiltration

4) Nonpharmacological methods

Question 19

Third Stage: Covered by meds admin previously (4)

Timing and Effectiveness of Pain Relief during Labor

Answer 19

No med admin
Third Stage os covered by meds admin previously
1) Epidural
2) Spinal Block
3)  Pudenal
4)  Local Infiltration

Nonpharmacological methods

Question 20

Nonpharmacological pain measures seek to reduce (3)

Gate-Control Theory of Pain based on?

Answer 20

Nonpharmacological pain measures seek to reduce anxiety, fear, and tension, which are
major contributing factors of pain in labor.
◯ Gate-control theory of pain is based on the concept that the sensory nerve pathways
that pain sensations use to travel to the brain will only allow a limited number of
sensations to travel at any given time. By sending alternate signals through these
pathways, the pain signals can be blocked from ascending the neurological pathway
and inhibit the brain’s perception and sensation of pain.
◯ The gate-control theory of pain assists in the understanding of how
nonpharmacological pain techniques can work to relieve pain.

Question 21

Interventions for nonpharmacological pain management

Answer 21

1) Childbirth preparation education,
2) sensory and cutaneous strategies,
3) frequent maternal position changes

Question 22

Childbirth preparation education

Interventions for nonpharmacological pain management

Answer 22

Childbirth preparation methods such as Lamaze, Bradley, Dick-Read methods
and/or pattern breathing methods are used to promote relaxation and pain relief

Question 23

Nursing implications for breathing techniques include

1) assessing for signs of?
2) Nursing Action?

Answer 23

Nursing implications for breathing techniques include assessing for signs of
1) hyperventilation (caused by low blood levels of PCO2 from blowing off too much CO2) such as light-headedness and tingling of the fingers.
2) If hyperventilation occurs, have the client breathe into a paper bag or her
cupped hands.

Question 24

Sensory stimulation strategies (based on the gate-control theory) to promote relaxation and pain relief name some?

Answer 24

Sensory stimulation strategies (based on the gate-control theory) to promote
relaxation and pain relief
☐ Aroma therapy
☐ Breathing techniques
☐ Imagery
☐ Music
☐ Use of focal points

Question 25

Cutaneous strategies (based on the gate-control theory) to promote relaxation and pain relief. Name some?

Answer 25

Cutaneous strategies (based on the gate-control theory) to promote relaxation
and pain relief
☐ Back rubs and massage
☐ Effleurage
X Light, gentle circular stroking of the client’s abdomen with the
fingertips in rhythm with breathing during contractions
☐ Sacral counterpressure
X Consistent pressure is applied by the support person using the heel of
the hand or fist against the client’s sacral area to counteract pain in the
lower back
☐ Heat or cold therapy
☐ Hydrotherapy (whirlpool or shower) increases maternal endorphin levels
☐ Intradermal water block
☐ Hypnosis
☐ Acupressure
☐ Transcutaneous electrical nerve stimulation (TENS) unit

Question 26

Frequent maternal position changes to promote relaxation and pain relief. Name Some?

Answer 26

■ Frequent maternal position changes to promote relaxation and pain relief
☐ Semi-sitting
☐ Squatting
☐ Kneeling
☐ Kneeling and rocking back and forth
☐ Supine position only with the placement of a wedge under one of the
client’s hips to tilt the uterus and avoid supine hypotension syndrome
◯ Client education
■ Teach the client who is in labor techniques to relieve labor pain, such as
patterned breathing and progressive relaxation exercises.

Question 27

Client Education: Teach the client who is in labor techniques to relieve labor pain, such as?

Answer 27

patterned breathing and progressive relaxation exercises.

Question 28

What is Effleurage?

Used to promote?

Answer 28

1) Nonpharm pain intervention. Cutaneous strategies
2) Used to promote relaxation and pain relief

(ATI 133)

Question 29

1) Patterned breathing exercises are used to promote ___ and ___. But they can cause Hyperventilation.
2) What causes Hyperventilation?

3) What are the signs of Hyperventilation?
4) What is a nursing invention to correct this?

Answer 29

1) relaxation and pain relief
2) Low levels of PCO2 from blowing off too much CO2
3) Light headedness, tingling of the fingers
3) Pt breath into a paper bag or cupped hands