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Flashcards in Pain Deck (108):
0

What can influence pain perception

Childbirth education
Cultural background
Fatigue/lack of sleep
Personal significance
Anxiety
Genetics
Previous experiences
Support

1

A laboring mother is very anxious, crying, and has a decreased perceptual field. You need her consent for the epidural. What should you do?

Wait until she calms down

2

Does quietness mean there is no pain

No

3

What is effacement

Thinning of the cervical area

4

What are the three phases in the first stage of labor

Latent
Active
Transition

5

What phase of labor is the most painful in the first stage

Transition

6

What causes the pain during the first stage

Hypoxic uterine cells
Pressure-adjacent structures( due to child coming down through pelvis) distention of lower uterus
Dilation, effacement, stretching of uterus

7

When does the second stage of labor start

When mother is 10 cm dilated

8

What causes the pain in the second stage

Hypoxic uterine cells
Distention- vagina and perineum (child has to come through)
Pressure-adjacent structures
Lacerations

9

When does the third stage of labor begin

After child is born

10

What causes the pain during the third stage

Contractions (much less intense)
Cervical dilation

11

How long should it take for placenta to be delivers

5-30 ,minutes

If it takes longer they need to use a D&C (cervical scrapping) to get placenta out

12

What is the one thing that all non pharmacological pain management tools include

Education

13

What are the goals of breathing patterns

Oxygenate
Relaxation
Decrease pain and anxiety
Slow breathing to prevent hyperventilation

14

Lamaze

Mind prevention
Controlled breathing, toning, relaxation

15

Bradley

Partner coached
Slow controlled abdominal breathing
Teaching techniques directed towards coach vs mother

16

Dick-read

Believes fear built state of tension

Knowledge to decrease pain and abdominal breathing

17

Kitzinger

Strong believer in home births

18

Hypnobreathing

Hypnotized

19

Effleurage

Rhythmic stroking if abdomen during pain

20

What is sacral pressure

Back rubs during contractions

21

Should you encourage or discourage vocalization during labor?

Encourage

Can promote relaxation and help to relieve tension

22

What is the goal of analgesics during labor

Relieve pain
Minimal motor blockage


Use small amount possible because baby will get it too

23

What happens if analgesics are given too early?
Too late?

Early- May prolong labor
Late- little value and may cause neonatal respiratory depressions

24

Contraindications for an epidural

Allergy
Compromised respiratory
Drug dependence
Fetal heart rate out of normal range
Meconium stained fluid
Infection/hypovolemia

25

Why is Meconium stained fluid a contraindication of epidural

That means the baby is already stressed and no more stress in the fetus is necessary

26

Does analgesia and anesthesia affect the fetus?

Yes, crosses placenta barrier

Fetal liver enzymes and renal system can't metabolize drugs yet

27

Stress ____ amount of blood volume to fetus brain

Increases

28

Labor may ____ drug clearance and _____ half-life of some drugs

Decrease

Increase

29

Is oral route used for laboring mom as a means of medical administration

No

Very rarely

30

Who can prescribe analgesic agents

Physician
Anesthesiologist
CRNA
CNM

31

Who makes the decision about when to give analgesic

Staff nurse

32

What do you have to assess before giving analgesics

Willingness or mother
Woman is uncomfortable
Stable VS
No allergies/ other contraindications
Fetal heart rate 110-160; reactive NST
Knowledge

33

When looking at results of an NST what is good; reactive or nonreactive

Reactive

34

What indicates a NST

Accelerations of 15 bpm lasting 15 seconds with each fetal movement

35

What does it mean if there are no accelerations in an NST

Bad results. Something could be wrong with fetus

36

What should you see with labor process after analgesics are given

Contractions: regular, increasing in intensity and duration
Cervical dilation
Station changing
Fetal presenting part descending

37

Side effects of analgesics

Decreased sensory perception
Maternal hypotension
Decreased fetal heart rate variability

38

Important things women need to know about pain relief medications before they are given

Type
Route
Expected effects
Implications for fetus/newborn
Side effects
Safety measures

39

What would you expect to find during assessment for labor progress in a woman where analgesia/anesthesia is given?

Contraction pattern to be regular, increasing intensity, and longer duration; cervical dilation; fetal presenting part descending showing no signs of distress; station of the fetal presenting part to be changing

40

What are some side effects that can occur when using analgesics during labor?

Maternal hypotension, lethargy, subdued mood, decreased sensory perception, decreased fetal HR variability, maternal and/or neonatal CNS depression, sleepiness, urinary retention (rare)

41

Why do some woman get IV fluids before getting analgesics

To prevent hypotension

42

When should you use analgesics cautiously

Hepatic function impairment, drug&alcohol dependent, physical dependence on benzodiazepines

43

What should the woman understand and know about pain relief meds before getting them

Type of medication administered, route of administration, expected effects of medication, implication for fetus/newborn, safety measures needed, side effect/complications

44

When are sedatives rarely used

In true labor

45

When are Barbiturates used?

Very latent phase, if used. You may send woman back home with these so she can sleep before delivery. Used if cervix is long, closed, thick

46

What are Barbituates? Examples?

They are sedatives
Secobarbital (Seconal)
Ambien

47

When are sedatives used?

Only used to decease anxiety, fear, apprehensiveness, and to promote sleep

48

What are actions or Benzodiazepines

Minor tranquilizing, sedative effects

49

Examples of benzodiazepines

Diazepam (Valium)
versed

50

What should you assess in somebody getting benzodiazepines

Assess for CNS depression in mom and newborn

51

Why may you give Versed?

Amnesic effect in OR procedures ; does not produce analgesia

52

Why is Versed not advised prior to delivery?

To prevent low Apgars

53

What is Benzodiazepine antidote/antagonist

Flumazenil
(Use is controversial)

54

What are three types of sedatives

Barbiturates
Benzodiazepines
Ataractics

55

What do Ataractics block

Action of histamines

56

Examples of Atraractics?

promethazine (Phenergan)
prochlorperazine (Compazine)
hydroxyzine (Vistaril)

57

How are Ataractics used? Why?

Used with opioid to decrease N&V and anxiety

58

Concerns for fetus with use of sedatives?

Deceased FHR variability and CNS depression in neonate

59

What are Narcotic Analgesics?

Opioids. They are drugs that enter the circulatory system and are distributed throughout the body and to the brain.

60

How do narcotic analgesics reduce pain?

Decease transmission of pain impulses; bind to receptor site pathways and transmit the pain signal to the brain

61

What are four examples of Narcotic Analgesics (opioids)

Butophanol tartrate (Stadol) -IV
Nalbuphine (Nubain)- IV
Hydrochloride (Demerol)
Fentanyl

62

What is most commonly used opioid

Demerol

63

What is it important to assess for with Nubain

Decreased FHR variability, respiratory depression, drowsiness, dizziness, blurred vision, diaphoresis, urinary urgency

64

What should you assess for with Stadol?

Urinary retention and respiratory depression

65

What is important about Butorphanol tartrate (Stadol)?

Crosses placenta and can cause respiratory depression. It is given IV

66

Route Nubain is given?

IV

67

What can reverse depressive effects of narcotics?

Naloxone (Narcan)

68

What is drug of choice when depressant is unknown?

Naloxone (Narcan)

69

Effects of Narcan

Little or no agonistic effect, little Pharmacologic activity in absence of narcotic agent

70

What can Narcan do to a neonate if mother has been given narcotics before delivery, close to time of birth?

Can reverse neonatal respiratory depression

71

What side effect can occur with Narcan although it is rarely seen

Urinary retention. Watch mom and babies output

72

If there is a Narcotic addiction what will you see?

Extreme withdraw symptoms

73

What may Agonist-Antagonist precipitate?

Drug withdraw in woman physically dependent on narcotics

74

Is there loss of conscious with regional analgesia/anesthesia

No loss of conscious

75

There is _____&______ blockage of impulses with Regional Analgesia/Anesthesia

Temporary and reversible

76

Examples of Regional Analgesia

Epidural block, combined spinal-epidural, local infiltration, pudendal block, intrathecal (spinal)

77

What happens with Regional Anesthesia?

Partial or complete loss of sensation below T8-T10 of spinal cord

78

Side effects of local anesthetics

Hypotension, Palpitations, dizziness, apprehension, tinnitus, vertigo, pruitus, confusion, headache, metallic taste in mouth, N&V, seizures, coma, urinary retention

79

Severe reactions with local anesthetics

Seldom seen, we don't let it get to this pint
Loss of consciousness, coma, severe hypotension, bradycardia, respiratory and cardiac arrest

80

Why and when do systematic toxic reactions most commonly occur ?

With an excessive dose because of too great a concentration or too large a volume

81

When is lumbar epidural administered?

1st and 2nd stage pain relief, administered in active labor

82

Where is lumbar epidural injected

Widest interspace below L2

83

Where does the lumbar epidural go into?

The epidural space (between the dura mater&vertebral canal)
Not into the dura!

84

Position for lumbar epidural

Left lateral best position. On side, back straight and vertical, shoulders square, upper leg prevented from rolling forward

85

What does lumbar epidural block

Entire pelvis: uterus, cervix, vagina, perineum

86

What are epidurals used for

Stage 1 through perineal repair

87

Considerations with epidural

Maternal hypotension, N&V, respiratory depression

88

What is it called when woman gets a epidural and she only feels pain on one side or a certain section

Spotty epidural

89

Epidurals administered for
_______ or _______ or ________

One time l&d.
Patient controlled using Indwelling catheter
Combined Spinal-Epidural Analgesia (CSE)

90

Characteristics of Combined Spinal-Epidural Analgesia (CSE)

Ability to bear down preserved; no loss of pushing reflex; motor power intact; can ambulate

91

What are nursing considerations with a traditional epidural

Increased incidence of forceps use or vacuum extractor; loss of sensation/bearing down reflex; considerably less risk than general anesthesia, may slow labor, increased incidence of oxytocin use, assist mom to avoid supine hypotension

92

Contraindications of regional epidurals

Risk of bleeding, coagulation disorders/defects, generalized sepsis, local infection @ needle site, back or spinal injury, maternal refusal

93

What should you remember needs to be done before regional anesthetics

Hydrate well prior to procedure. (500-2000cc)
Helps prevent hypotension

94

With general anesthetics what is mother at risk for

Hypotension, urinary retention, N&V, occasional HA or backache

95

Where is spinal block injected into

Subarachnoid space

96

What is advantage of spinal block

Immediate onset of anesthesia, smaller drug amount required

97

What may occur with spinal block

Headache

98

What should you know about pudenal block

Deep into lower side of vagina, blocks perineum and bathes pudenal nerve; for birth use forceps, vacuum extractor, episiotomy repair; No contraindications; coach client in pushing

99

When is pudenal block done

Just prior to birth inside pudendal nerve

100

What could be going on mother is complaining extra about pain in bottom

Could have hemorrhoids

101

What is anesthesia for laceration or episiotomy repair

Local infiltration

102

Does local infiltration require small or large amounts of agent

Large

103

When is local infiltration administered

Just prior to birth

104

What are side effects of local infiltration

No side effects for mom or newborn

105

What is general anesthesia

Induced unconsciousness, not used a lot, IV or inhalation, used in a ER situation that does not allow for other techniques

106

What are complications of general anesthesia

Fetal depression, failure to establish patent airway in woman, uterine relaxation which makes you watch for bleeding, maternal vomiting

107

When inserting tube for general anesthesia watch _________ during rapid induction of anesthesia

Cricoid pressure