Pain Management During Labor and Birth PDF (4/3/2024)

4/3/2024 PAIN MANAGEMENT DURING LABOR AND BIRTH NP03L004 ELO B · VERSION 2.0 INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING, 8TH ED., PP. 164 – 182 1 TERMINAL LEARNING OBJECTIVE Given a scenario of a patient experiencing childbirth, perform sage and ef...

4/3/2024 PAIN MANAGEMENT DURING LABOR AND BIRTH NP03L004 ELO B · VERSION 2.0 INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING, 8TH ED., PP. 164 – 182 1 TERMINAL LEARNING OBJECTIVE Given a scenario of a patient experiencing childbirth, perform sage and effective nursing care for a patient in labor without harm to the patient or fetus. 2 ENABLING LEARNING OBJECTIVE Perform nursing care on a laboring patient experiencing pain during labor and birth. 3 1  4/3/2024 PROMOTE COMFORT IN A LABORING PATIENT THROUGH A VARIETY OF INTERVENTIONS 4 NATURE OF PAIN DURING CHILDBIRTH Childbirth Preparation Classes Changes of pregnancy Fetal development Prenatal Care Hazardous substances Good nutrition and exercise benefits Relieving common discomforts Working during pregnancy Coping with labor Pain management Care of infant Growth and development 5 NATURE OF PAIN DURING CHILDBIRTH Special classes for unique circumstances Gestational Diabetes Exercise Sibling Grandparent Breastfeeding Infant Care Cesarean and vaginal birth after cesarean (VBAC) Adolescent childbirth Refresher classes 6 2  4/3/2024 NATURE OF PAIN DURING CHILDBIRTH Childbirth pain differs from other types of pain It is part of a normal process Preparation time exists It is self-limiting Lasts for hours Labor pains end with the birth of a baby 7 VARIABLES IN CHILDBIRTH PAIN Factors that influence pain experiences Pain Threshold Pain perception Pain Tolerance Modify factors to allow tolerance 8 VARIABLES IN CHILDBIRTH PAIN Sources of pain Dilation and stretching of the cervix Reduced uterine blood supply during contractions Pressure of the fetus on pelvic structures Stretching of the vagina and perineum 9 3  4/3/2024 VARIABLES IN CHILDBIRTH PAIN Physical Factors CNS Endorphin levels 10 VARIABLES IN CHILDBIRTH PAIN Maternal condition Cervix Pelvis Labor intensity Fatigue 11 VARIABLES IN CHILDBIRTH PAIN Fetal presentation and position Abnormal presentation Fetal occiput posterior 12 4  4/3/2024 VARIABLES IN CHILDBIRTH PAIN Caregiver interventions IV lines Continuous fetal monitoring Amniotomy Vaginal exams Psychosocial and cultural factors 13 CHECK ON LEARNING A pregnant woman asks if she should take prepared childbirth classes. The best response of the nurse is to tell her that classes will: a. Allow her to avoid pain medications during labor b. Be required if her partner wants to be with her c. Provide methods to help her cope with labor d. Reduce the likelihood that complications will occur 14 PAIN MANAGEMENT NON-PHARMACOLOGIC METHODS 15 5  4/3/2024 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 16 NON-PHARMACOLOGIC METHODS Application of Techniques Relaxation Skin stimulation Positioning Diversion and distraction Focal point technique Imagery Music/TV/Electronic devices Breathing Techniques 17 NON-PHARMACOLOGIC METHODS Relaxation Adjusting the environment Offer warm shower Orient to environment Educating about signs of tension/release that tension Change methods 18 6  4/3/2024 NON-PHARMACOLOGIC METHODS Skin stimulation Effleurage Sacral pressure Thermal stimulation 19 NON-PHARMACOLOGIC METHODS Positioning 20 NON-PHARMACOLOGIC METHODS Diversion and distraction Focal point Imagery Music Television 21 7  4/3/2024 NON-PHARMACOLOGIC METHODS Breathing Techniques Cleansing breath First Stage Modified-Paced Breathing Slow-Paced Breathing Patterned Paced Breathing 22 NON-PHARMACOLOGIC METHODS Breathing Techniques Second Stage 23 NON-PHARMACOLOGIC METHODS Nursing Role Assess prior knowledge and preparation Guide and educate Minimize environmental stimuli Assess pain and adequacy of relief measures 24 8  4/3/2024 CHECK ON LEARNING Which technique is likely to be most effective for back labor? a. Stimulating the abdomen by effleurage b. Applying firm pressure in the sacral area c. Blowing out in short breaths during each contraction d. Rocking from side to side at the peak of each contraction 25 CHECK ON LEARNING According to the gate control theory, which technique should be most helpful in interrupting transmission of labor pain to the brain? a. Rapid, shallow breathing b. Application of heat c. Focusing on a point in the room d. Listening to music 26 CHECK ON LEARNING A woman is using prepared childbirth breathing techniques and complains of tingling in her fingers and dizziness. The nurse should: a. Have her breath rapidly with contractions b. Ask her if she feels an urge to push or bear down c. Tell her to exhale slowly into her cupped hands d. Reassure her that these sensations are normal 27 9  4/3/2024 PAIN MANAGEMENT PHARMACOLOGIC METHODS 28 PHARMACOLOGIC METHODS Physiology of pregnancy and analgesia & anesthesia Higher risk of hypoxia Increased risk of vomiting and aspiration Increased risk of hypotension and shock Effects on fetal must be considered 29 PHARMACOLOGIC METHODS Advantages More active participant in birth Helps her relax and work with contractions Decreases stress response Limitations Medicate two persons: mother and fetus May slow progress of labor Complications or medications may limit options 30 10  4/3/2024 PHARMACOLOGIC METHODS Narcotic Analgesics Frequent small doses Avoid if birth is expected within one hour Common drugs Meperidine (Demerol) Fentanyl (Sublimaze) Nalbuphine (Nubain) Safety protocols 31 PHARMACOLOGIC METHODS Narcotic Antagonist Naloxone (Narcan) Reverse respiratory depression usually in infant Adjunct drugs (not pain relievers) Benzodiazepines Relieve anxiety and nausea Affect the variability of FHR Delay infant’s thermoregulation 32 PHARMACOLOGIC METHODS Anesthetics Cause loss of sensation Blocks pain and motor responses Feels pressure and possibly some pain Inhaled (Nitrous Oxide) Via face mask at the peak of contraction No effect to mother or fetus 33 11  4/3/2024 PHARMACOLOGIC METHODS Regional Epidural Block Used for vaginal or C-section Combine anesthetic drugs Infused through catheter Adverse Effects Maternal hypotension Urinary retention Prolonged second stage of labor 34 PHARMACOLOGIC METHODS Regional Subarachnoid Block Used for C-section ONLY Use less medication “one-shot” injection Losses all sensation and movement Adverse effects Maternal Hypotension Urinary Retention Post-spinal headache 35 PHARMACOLOGIC METHODS 36 12  4/3/2024 PHARMACOLOGIC METHODS Local block Used for episiotomy or laceration repair Injection numbs the area Pudendal block Used for vaginal birth, episiotomy, forceps-assisted birth Adverse effects Vaginal hematoma Abscess 37 PHARMACOLOGIC METHODS General Anesthesia Emergency cesarean delivery Contraindication to regional block for cesarean delivery Adverse maternal effects Vomiting with aspiration Adverse fetal effects Respiratory depression 38 PHARMACOLOGIC METHODS Nursing Role Thorough admission intake Maintain safety Provide education Assist the HCP Manage medication effects and patient response 39 13  4/3/2024 CHECK ON LEARNING Which of the following is most appropriately used for pain relief during labor when the cervix is dilated less than 4 cm? a. Naloxone (Narcan) via IV route b. Meperidine (Demerol) via IM route c. Promethazine (Phenergan) via PO route d. Fentanyl (Sublimaze) via epidural route 40 CHECK ON LEARNING Select the most important nursing assessments immediately after a woman receives an epidural block. a. Bladder distention b. Condition of IV site c. Fetal heart rate d. Blood pressure 41 CHECK ON LEARNING Immediately after birth, nursing care for the woman who had subarachnoid block anesthesia for a repeat cesarean birth should include: a. Ambulating within 2 hours of birth b. Keeping her back curved outward c. Assessing for return of sensation d. Keeping her flat in bed for 8 hours 42 14  4/3/2024 REVIEW OF MAIN POINTS Promoting comfort The nature of pain during labor Nonpharmacologic pain management Pharmacologic pain management 43 QUESTIONS? 44 15