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A pregnant woman asks if she should take prepared childbirth classes. The best response of the nurse is to tell her that classes will:
Which technique is likely to be most effective for back labor?
According to the gate control theory, which technique should be most helpful in interrupting the transmission of labor pain to the brain?
A woman is using prepared childbirth breathing techniques and complains of tingling in her fingers and dizziness. The nurse should:
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Which of the following is most appropriately used for pain relief during labor when the cervix is dilated less than 4 cm?
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Select the most important nursing assessments immediately after a woman receives an epidural block.
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What are some non-pharmacologic methods for pain management during labor?
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Describe the risks associated with pharmacologic pain management during labor.
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The natural process of ________ can lead to a variety of pain experiences during childbirth.
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Pain during childbirth is considered ________, as it is self-limiting and part of a normal process.
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What is a primary limitation of pharmacologic methods for pain management during labor?
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Which method of analgesia is specifically contraindicated for Cesarean delivery?
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Which potential side effect is associated with the administration of a regional epidural block?
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What should the nurse monitor after a woman receives a local block for an episiotomy repair?
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What is a key characteristic of narcotic analgesics used during labor?
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What is a primary advantage of non-pharmacologic pain management methods during labor?
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Which non-pharmacologic technique involves creating a mental picture to help with pain management?
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Which of the following methods would best provide distraction during labor?
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What should be assessed before teaching non-pharmacologic pain management techniques to a laboring woman?
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Which of the following is a limitation of non-pharmacologic methods for pain management?
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What is a recommended position change to assist with pain relief during labor?
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Which breathing technique is specifically mentioned for the second stage of labor?
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Which of the following scenarios best illustrates the use of skin stimulation during labor?
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What is the role of a nurse in the context of non-pharmacologic pain management during labor?
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Which technique is least likely to be helpful as a form of distraction during labor?
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What is a key characteristic of pain during childbirth compared to other types of pain?
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Which factor is NOT considered a source of pain during childbirth?
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How can caregiver interventions influence childbirth pain?
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What defines the pain threshold in labor?
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What is NOT a psychosocial factor that can influence pain during childbirth?
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What is a common misconception about pain during childbirth?
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Which of the following describes an aspect of pain tolerance during labor?
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Study Notes
Pain Management During Labor and Birth
- Terminal Learning Objective: To provide safe and effective nursing care to a patient experiencing childbirth without harming the patient or fetus.
- Enabling Learning Objective: To perform nursing care on a laboring patient experiencing pain during labor and birth.
Nature of Pain During Childbirth
- Childbirth pain is different from other types of pain: it is part of a normal process, there is preparation time, it is self-limiting, and lasts for hours, ending with the birth of a baby.
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Variables that influence pain experiences:
- Pain threshold: Perception of pain
- Pain tolerance: Ability to modify factors to endure pain.
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Sources of pain during labor:
- Cervical dilation and stretching
- Reduced uterine blood supply during contractions
- Pressure of the fetus on pelvic structures
- Stretching of the vagina and perineum
Variables in Childbirth Pain
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Physical Factors:
- Central Nervous System (CNS): Brain's processing of pain signals
- Endorphin Levels: Naturally occurring pain relievers
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Maternal Condition:
- Cervix: Dilatation and effacement
- Pelvis: Size and shape
- Labor Intensity: Strength and frequency of contractions
- Fatigue: Level of exhaustion
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Fetal Presentation and Position:
- Abnormal Presentation: Breech, transverse, or other non-cephalic positions
- Fetal Occiput Posterior (FOP): Baby's head facing the mother's back, leading to intense back pain
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Caregiver Interventions:
- IV Lines: For medication administration
- Continuous Fetal Monitoring: To monitor fetal heart rate
- Amniotomy: Artificial rupture of membranes
- Vaginal Exams: To assess cervical dilation and effacement
- Psychosocial and Cultural Factors: Beliefs, attitudes, and previous experiences influence pain perception.
Pain Management: Non-pharmacologic Methods
- Advantages: No harm to mother or fetus, no slowing of labor process, no risk of allergy or adverse reactions.
- Limitations: Require teaching and rehearsal, often covered in childbirth preparation classes.
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Techniques:
- Relaxation: Adjusting environment, offering warm showers, educating about tension recognition and release techniques.
- Skin Stimulation:
- Effleurage: Light, circular strokes on the abdomen
- Sacral Pressure: Firm pressure on the lower back
- Thermal Stimulation: Warm compresses or cold packs
- Positioning: Finding comfortable positions like squatting, rocking, or leaning forward.
- Diversion and Distraction: Focal point, imagery, music, television.
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Breathing Techniques:
- Cleansing Breath: Deep inhales and exhales to promote relaxation
- First Stage:
- Modified-Paced Breathing: Combining slow and quick breaths
- Slow-Paced Breathing: Long, deep breaths
- Patterned Paced Breathing: Using specific breathing patterns
- Second Stage: Panting, blowing, or pushing techniques to help with pushing efforts
- Nursing Role: Assess prior knowledge and preparation, guide and educate, minimize environmental stimuli, and assess pain and adequacy of relief measures.
Pain Management: Pharmacologic Methods
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Physiology of Pregnancy and Analgesia & Anesthesia:
- Higher Risk of Hypoxia: Decreased oxygen levels in the blood
- Increased Risk of Vomiting and Aspiration: Risk of inhaling stomach contents
- Increased Risk of Hypotension and Shock: Low blood pressure and circulatory collapse
- Fetal Effects: Must be considered when administering medications
- Advantages: More active participation in birth, helps with relaxation, decreases stress response.
- Limitations: Medicate mother and fetus, may slow labor progress, complications or medications may limit options.
Pharmacologic Methods: Medications
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Narcotic Analgesics:
- Frequent Small Doses: To minimize adverse fetal effects
- Avoid if Birth is Expected Within One Hour: To minimize risk of respiratory depression to the infant
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Common Drugs:
- Meperidine (Demerol)
- Fentanyl (Sublimaze)
- Nalbuphine (Nubain)
- Safety Protocols: Close monitoring of maternal and fetal vital signs
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Narcotic Antagonist:
- Naloxone (Narcan): Reverses respiratory depression, often used in infants
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Adjunct Drugs:
- Benzodiazepines: Relieve anxiety and nausea, but affect fetal heart rate variability and delay infant thermoregulation.
Pharmacologic Methods: Anesthetics
- Anesthetics: Cause loss of sensation, blocking pain and motor responses, but allowing the sensations of pressure and possibly some pain.
- Inhaled (Nitrous Oxide): Administered via face mask at the peak of contractions, with minimal effects on mother and fetus.
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Regional:
- Epidural Block: Used for vaginal or cesarean births, combines anesthetic drugs infused through a catheter.
- Adverse Effects: Maternal hypotension, urinary retention, prolonged second stage of labor
- Subarachnoid Block: Exclusively for cesarean births, requires less medication and involves a "one-shot" injection.
- Adverse Effects: Maternal hypotension, urinary retention, post-spinal headache
- Local Block: Used for episiotomy or laceration repair, an injection numbs the area.
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Pudendal Block: Used for vaginal birth, episiotomy, or forceps-assisted birth.
- Adverse Effects: Vaginal hematoma (a collection of blood under the skin) or abscess (infected pus pocket).
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General Anesthesia: Used for emergency cesarean deliveries, contraindicated if regional block is not an option.
- Adverse Maternal Effects: Vomiting with aspiration
- Adverse Fetal Effects: Respiratory depression.
- Nursing Role: Thorough admission intake, maintain safety, provide education, assist the healthcare provider, and manage medication effects and patient response.
Pain Management During Labor and Birth
- The terminal learning objective is for students to understand how to provide effective nursing care during childbirth without harm to the mother or fetus.
- The enabling learning objective is for students to perform nursing care on a laboring patient experiencing pain during labor and birth.
- The content is from "Introduction to Maternity and Pediatric Nursing, 8th ed., pp. 164-182".
Nature of Pain During Childbirth
- Childbirth pain is a normal part of the birthing process.
- It is self-limiting and ends with the birth of the baby.
- Classes can teach mothers how to cope with pain, such as relaxation techniques, breathing exercises, and positioning.
Variables in Childbirth Pain
- Pain perception and pain tolerance are influenced by various factors, including physical factors, maternal condition, fetal presentation and position, caregiver interventions, and psychosocial and cultural factors.
- Physical factors such as the central nervous system, endorphin levels, and the mother's cervix, pelvis, labor intensity, and fatigue can all impact pain levels.
- Fetal presentation and position can also influence pain levels, with abnormal presentation or a fetal occiput posterior position often increasing discomfort.
- Caregiver interventions, such as IV lines, continuous fetal monitoring, amniotomy, and vaginal exams, can also contribute to pain.
Pain management - Non-Pharmacologic Methods
- Advantages: No harm to mother or fetus, no slowing of labor process, no risk of allergy or adverse reactions.
- Limitations: Should be taught and rehearsed. Often covered in childbirth preparation classes.
- Techniques: Relaxation, skin stimulation, positioning, diversion and distraction, focal point technique, imagery, music/TV/electronic devices, breathing techniques.
Non-Pharmacological Techniques
- Relaxation: Adjust the environment, offer a warm shower, orient to the environment, educate about signs of tension, and change methods when necessary.
- Skin stimulation: Effleurage (light stroking of the abdomen), Sacral pressure (firm pressure on the lower back), and Thermal stimulation (using heat or cold).
- Positioning: Encourage different positions to alleviate pressure and promote comfort.
- Diversion & Distraction: Utilize a focal point (look at a specific object), Imagery (visualize pleasant scenes), Music, and Television.
- Breathing Techniques: Cleansing breath (take a deep breath and exhale fully), Slow-paced breathing (take deep breaths and exhale slowly), Modified paced breathing (combines slow-paced breathing with panting), and Patterned paced breathing (use rhythmic breathing patterns).
Pain management - Pharmacologic Methods
- Advantages: Helps the mother relax and work with contractions, decreases the stress response.
- Limitations: Medicate both the mother and fetus, may slow the progress of labor, complications or medications may limit options.
- Narcotic Analgesics: Frequent small doses are often used, but should be avoided if birth is expected within one hour. Common drugs include Meperidine (Demerol), Fentanyl (Sublimaze), and Nalbuphine (Nubain).
- Narcotic Antagonist: Naloxone (Narcan) can reverse respiratory depression, usually in the infant.
- Adjunct Drugs: Benzodiazepines (such as diazepam or alprazolam) can relieve anxiety and nausea, but may affect the variability of fetal heart rate and delay infant thermoregulation.
- Anesthetics: Cause loss of sensation, blocking pain and motor responses.
Types of Anesthesia
- Inhaled Anesthesia (Nitrous Oxide): Can be administered via a face mask at the peak of contraction. There is little effect on the mother or fetus.
- Regional Anesthesia: Epidural Block (used for vaginal or C-section deliveries), Subarachnoid Block (used for C-section only), and Local Block (used for episiotomy or laceration repair).
- Pudendal Block: Used for vaginal birth, episiotomy, or forceps-assisted birth.
General Anesthesia
- Useful for emergency cesarean delivery, but also has adverse maternal and fetal effects.
- Adverse Maternal Effects: Vomiting with aspiration.
- Adverse Fetal Effects: Respiratory depression.
Pain Management Nursing Role
- Perform a thorough admission intake, maintain patient safety, provide education to the patient, assist the healthcare provider, and manage medication effects and patient response.
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Description
This quiz focuses on the nursing care provided to patients experiencing pain during labor and childbirth. It aims to educate on the unique nature of childbirth pain, its influencing variables, and effective pain management techniques. Understanding these concepts is crucial for ensuring safety and comfort for both the patient and fetus.
