TBL: maximizing comfort for the laboring woman Flashcards
(93 cards)
1
Q
where are pain impulses transmitted from during the first stage of labor?
A
T1 and T2 spinal nerve segment and accessory lower thoracic and upper lumbar sympathetic nerves
2
Q
what pain is considered visceral pain during the first stage of labor?
A
distention of the lower uterine segment
stretching of cervical tissue as it effaces and dilates
pressure and traction on adjacent structures
3
Q
where does referred pain from the uterus radiate?
A
abdominal wall lumbosacral area of the back iliac crests gluteal area thighs lower back
4
Q
During the first stage of labor, when is the woman usually at a state of discomfort?
A
only during contractions
5
Q
If the fetus is in a posterior position, when is the mother in pain?
A
in between contractions as well as during
6
Q
During the second stage of labor, the woman has somatic pain. What is this described as?
A
intense
sharp
burning
well localized
7
Q
What two factors can increase the amount of pain and discomfort a laboring woman experiences?
A
fear
lack of information
8
Q
what endogenous opioids are secreted by the pituitary gland and act on the central and peripheral nervous systems to reduce pain?
A
beta-endorphins
9
Q
what are the 2 most helpful interventions in enhancing comfort?
A
- caring nursing approach
- a supportive presence
10
Q
what should the labor/delivery environment include?
A
- space for movement, ambulation, and equipment such as birthing balls
- comfortable chairs, tubs, and showers readily available
- items from home such as pillows, objects for focal point, music, iPad, or DVDs
11
Q
what is an advantage of non pharmacological methods of pain relief compared to pharmacological methods?
A
non pharmacological methods allow the normal course of labor to progress more efficiently while pharmacological methods tend to interrupt or even slow the labor process
12
Q
which herbal tea helps women in labor relax?
A
chamomile
13
Q
which herbal tea reduces nausea?
A
lemon balm
peppermint
14
Q
which herbal tea enhances energy and reduces fatigue?
A
ginger
ginseng
15
Q
what is the purpose of breathing techniques in the first stage of labor?
A
promotes relaxation of the abdominal muscles and thereby increase the size of the abdominal cavity
16
Q
what is the purpose of breathing techniques in the second stage of labor? what may this prevent?
A
- increases abdominal pressure and thereby assist in expelling the fetus
- used to relax the pudendal muscles to prevent precipitate expulsion of the fetal head
17
Q
how can a nurse help a woman in labor with breathing techniques?
A
model breathing techniques
breathe in synchrony with the woman and her partner
18
Q
what is slow-paced breathing? when is it initiated?
A
- performed at approximately half the woman’s normal breathing rate
- when she can no longer walk or talk through contractions
19
Q
what is modified-paced breathing? when is it initiated?
A
- shallower and faster
- should never exceed twice her resting respiratory rate
- when the contractions increase in frequency and intensity
20
Q
what is patterned-paced breathing? when is this initiated?
A
- consists of panting breaths combined with soft blowing breaths at regular intervals
- during the transition phase of the first stage of labor, when the cervix dilates from 8 cm to 10 cm
21
Q
what is an undesirable reaction to patterned-paced breathing?
A
hyperventilation
22
Q
symptoms of respiratory alkalosis? what causes this? tx?
A
lightheadedness
dizziness
tingling of the fingers
circumoral numbness
hyperventilation
breathing into a paper bag or hands
23
Q
what is cleansing breathing?
A
in through the nose and out through the mouth
used at the beginning and end of each contraction
24
Q
what is effleurage?
A
light massage or stroking of the abdomen, thigh, or chest in rhythm with breathing during contractions used to distract the woman from contraction pain
25
what is counterpressure?
steady pressure applied by a support person to the sacral area with a firm object or the fist or heal of a hand
helpful for back pain
can be applied to both hips or to the knees
26
what is therapeutic touch?
uses laying on of hands by a specifically trained person to redirect energy fields associated with pain
27
when is hydrotherapy usually initiated?
when the woman is in active labor 5cm dilated
28
what is contraindicated when using jet hydrotherapy?
use of internal electrodes
29
what is the time limit for jet hydrotherapy?
30-60 minutes at a time
30
what part of the body should stay out of the water at all times?
her shoulders should remain out of water to facilitate the dissipation of heat
31
what can warm water cause? nursing interventions
- dizziness
- a shower stool should always be available
- woman should be assisted when getting in and out of the tub
32
what is an intradermal water block?
the injection of small amounts of sterile water by using a fine needle into four locations on the lower back to relieve low back pains
can be repeated
33
what will be expected within 20-30 mins of intradermal water block?
intense stinging
relief of back pain for up to 2 hours
34
what do lavender, rose, and jasmine oils promote?
relaxation
| reduce pain
35
what does rose oil act as?
an antidepressant and uterine tonic
36
what does jasmine oil strengthen?
strengthens contractions and decreases feelings of panic in addition to reducing pain
37
what do bergamot or rosemary relieve?
relieves exhaustion
38
what should you always watch out for with essential oils and herbs?
allergic reaction
39
what is hypnosis?
a form of deep relaxation, similar to day dreaming or meditation
women are in a state of focused concentration and the subconscious min can be more easily accessed
40
what are the possible side effects of unsuccessful hypnosis?
mild dizziness
nausea
headache
41
what is the purpose of a sedative?
given to lessen the intensity of the contraction, decrease anxiety, or promote sleep
42
which barbiturate can cause an undesirable effect? what is that undesirable effect? how long before birth should this drug be avoided?
secobarbital sodium (Seconal)
respiratory and vasomotor depression for mother and baby
avoided 12-24 hours before birth
43
which antiemetic is found to work best with analgesics?
Metoclopramide (Reglan)
44
what is the major disadvantage to diazepam?
it disrupts thermoregulation in newborns making them less able to maintain body temperature
45
what is the antidote for benzodiazepines-induces respiratory depression and sedation?
Flumazenil (Romazicon)
46
where is a spinal anesthesia block injected? where is the anesthesia affective for a vaginal birth? where is it affective for a c-section birth?
injected through the third, fourth, or fifth lumbar interspace into the subarachnoid space
vaginal: hips (T10)- the feet
c-section: nipple (T6)-the feet
47
what is the position of the woman during spinal anesthesia injections?
the woman sits or lies on her side (modified Sims position) with back curved to widen the intervertebral space
48
how does the nurse support the woman during spinal anesthesia injections?
encourages her to use breathing techniques
relaxation techniques
reminds her to sit still during the placement of the spinal needle
49
when is the anesthetic inserted for a spinal anesthesia?
between contractions
50
how may the woman be positioned after the injection of spinal anesthesia for vaginal birth? c-section birth?
vaginal birth: upright to allow the heavier anesthetic solution to flow downward
c-section birth: supine with head and shoulders slightly elevated
51
how does the nurse help prevent supine hypotensive syndrome in a patient who just received a spinal anesthesia for a c-section birth?
displace the uterus laterally by tilting the operating table or placing a wedge under one of her hips
52
how long does it take for a spinal anesthesia block to take full effect? how long will this last?
5-10 minutes
can creep upwards for 20 minutes or longer
lasts 1-3 hours
53
when would you not give someone a spinal anesthesia?
if the woman has a tattoo at the site where the needle would be inserted
the risk of transmission of pathogens is too high
54
what side effects may occur with a spinal anesthesia?
hypotension
impaired placental perfusion
ineffective breathing pattern
55
how often would you assess vital signs before the administration of a spinal anesthetic? after?
every 20-30 minutes
every 5-10 minutes
56
what may be given 15-30 minutes before induction of a spinal anesthetic to decrease the potential of hypotension? what may this NOT contain because it can cause neonatal hypoglycemia?
bolus of IV fluid
dextrose
57
what vital signs indicate an emergency situation of maternal hypotension and decreased placental perfusion?
maternal hypotension: drop in systolic BP to 100 mmHg or less (20% below baseline BP)
fetal distress: bradycardia, minimal or absent variability, or late decelerations
58
interventions for maternal hypotension with decreased placental perfusion?
* *turn woman to lateral position or place pillow or wedge under hip to displace uterus
- maintain IV infusion at rate specified, or increase per hospital
- administer O2 with nonrebreather mask at 10-12 L/min
- elevate the woman's legs
- notify HCP
- administer IV vasopressor (ephedrine) if previous measures are ineffective
- remain with woman, continue to monitor vitals every 5 minutes until condition is stable or per HCP order
59
what is a postdural puncture headache (PDPH) aka spinal headache?
leakage of CSF from the site of the puncture of the dura mater
occurs when the dura is accidentally punctures during the spinal anesthetic administration
60
when do the symptoms of a PDPH begin to show? what are these symptoms? what may relieve these?
begins within 2 days of the puncture and may persist for days or weeks
headache, tinnitus, blurred vision, photophobia
sitting in an upright position may relieve these symptoms
61
treatment for PDPH?
oral analgesics
methylxanthines (caffeine or theophylline)
autologous blood patch
62
what is an epidural?
anesthetic or opioid analgesics injected into the fourth or fifth lumbar vertebrae into the epidural space
63
which is the most effect pharmacologic pain relief method for labor?
epidural
64
where is block required by an epidural for a vaginal birth? c-section birth?
vaginal: T10-S5
| c-section: T8-S1
65
what does the epidural relieve? what does it not relieve?
relieves pain caused by uterine contractions
does not relieve the pressure sensations that occur as the fetus descends in the pelvis
66
what needle is used for an epidural
large bore needle
67
before injecting a woman with a large amount of medication during an epidural what is done?
a small amount of medication is injected to be sure the catheter has not been accidentally placed in the subarachnoid space or in a blood vessel
68
what condition may make an epidural injection difficult?
obesity
69
does general anesthesia or an epidural present less risk for an obese woman?
epidural
70
after the epidural has been administered, how should a woman be positioned?
on her side so that the uterus doesn't compress the ascending vena cava and descending aorta
alternate side to side every hour
71
what is an intermittent block? how common is this?
repeated injections of anesthetic solutions
least common
72
advantages of an epidural block?
- woman remains alert and is more comfortable and able to participate
- good relaxation is achieved
- airway reflexes remain intact
- only partial motor paralysis develops
- gastric emptying is not delayed
- blood loss is not excessive
73
disadvantages of an epidural?
- woman's ability to move freely and to maintain control of her labor is limited
- CNS effects may occur if solution containing a local anesthetic agent is injected into a blood vessel
- respiratory arrest may occur if dose is too high
- higher rate of fever especially if labor lasts longer than 12 hours
74
side effects of epidural and spinal anesthesia?
```
hypotension
fever
urinary retention
local anesthetic toxicity
itching
limited movement
longer second stage of labor
increased use of oxytocin
increased likelihood of forceps or vacuum assisted birth
```
75
s/s of local anesthetic toxicity?
```
lightheadedness
dizziness
tinnitus
metallic taste
numbness of the tongue and mouth
bizarre behavior
slurred speech
convulsions
loss of consciousness
```
76
which opioid is major cause of pruritus?
fentanyl
77
what is the combined spinal-epidural analgesia technique referred to as?
walking epidural
78
side effects of a walking epidural? what may be given to manage these side effects without decreasing the level of analgesia achieved?
pruritus
urinary retention
respiratory depression
nausea
naloxone
79
which opioids are commonly used alone to produce a rapid onset of pain relief without causing maternal hypotension or affecting vital signs? who is this most likely given to?
fentanyl
sufentanil
preservative-free morphine
nulliparous women or women with a hx of long labors
80
what are the epidural block effects on the newborn?
little or no lasting effect on the physiologic status of the newborn
81
what is nitrous oxide?
nitrous oxide mixed with oxygen and inhaled via face mask in a low concentration to provide analgesia during the first and second stages of labor
82
side effects of nitrous oxide?
nausea
vomiting
dizziness
drowsiness
83
how often is general anesthesia used for a uncomplicated vaginal birth? c-section birth?
rarely
10% of c-section births in the US
84
what is priority for recovery room care after general anesthesia to prevent postpartum hemorrhage?
maintain an open airway
85
what part does the nurse play in the informed consent?
clarifying and describing procedures
acting as a the woman's advocate and asking the HCP for further explanations
86
two nursing diagnoses for nonpharmcological pain management?
anxiety r/t lack of confidence in ability to cope effectively with pain during labor
readiness for enhanced childbearing process r/t desire for healthy outcome of labor and birth
87
what should the woman be reminded to do before the analgesic or anesthetic administration?
empty her bladder
88
what should the nurse tell the woman it will feel like when the catheter is threaded into the epidural space?
she may have a momentary twinge down her leg, hip, or back
not a sign of injury
89
is IM a perferred route for women in labor?
No
90
nursing interventions prior to an epidural or spinal anesthesia?
- assist HCP to explain the procedure, answer any questions, and obtain informed consent
- assess maternal vital signs, level of hydration, labor progress, and FHR/pattern
- start and IV line and infuse and bolus of fluid if ordered
- obtain lab results
- assess the woman's level of pain using a pain scale
- assist the woman to void
91
nursing interventions during initiation of an epidural or spinal anesthesia?
- assist the woman with assuming and maintaining proper positioning
- verbally guide the woman through the procedure, explaining sounds and sensations as she experiences them
- assist the anesthesia care provider with documentation of vital signs, time, and amount of medications given
- monitor maternal vital signs and FHR
- have oxygen and suction available
- monitor for signs of local anesthetic toxicity as the test dose is adminstered
92
nursing interventions while the block is in place?
- continue to monitor vitals
- continue to assess pain scale with vitals
- monitor for bladder distention
- insert a urinary catheter if necessary
- encourage and assist woman to change positions every hour
- promote safety
- keep epidural catheter insertion site clean and dry
- continue to monitor for anesthetic side effects
93
nursing interventions while the block is wearing off after birth?
- assess regularly for return of sensory and motor function
- continure to monitor vital signs
- monitor for bladder distention
- promote safety
- keep the insertion site clean
- continue to monitor for anesthetic side effects
