Discomfort and Pain Management49 cards

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On Admission, What should the nurse talk to the patient with concerning her plans for pain management?

- pain management plans (pillows, music, visual imagery, etc) -knowledge about non-pharm adn pharm pain management options -past hx with pain management -look over her chart and discuss allergies and any medical conditions that will/ may lim


What are some discomforts that women experience during labor and delivery? (8)

-pain -uncomfortable position -infrequent position changes -diaphoresis -leaking of amniotic fluid after rupture -dry mouth -anxiety -fear


What is a female patients behavior like during early labor??

-less intense and frequent contractions -aware of environment -talkative -does not mind being touched -can follow directions and focus


What is a female patients behavior like during active/transition/stage 2 of labor like?

-contractions more frequent and intense -less aware of environment -less talkative -may not want to be touched -cannot follow directions and can't focus


What are signs that the patient is coping with her discomfort?

-low moaning deep in throat -rocking or swaying -counting -facial grimacing -talking, watching TV btwn contraction -able to rest btwn contractions -receptive to trying non-pharm interventions


What are signs that the patient is experiencing INEFFECTIVE coping?

-crying, screaming, hitting -increase pulse, resp rate, and bp -dilated pupils -muscles tense during contractions and not resting btwn contractions -not receptive to trying non-pharm interventions.


What are the goals of pain/discomfort management

-relax tense muscles -distract teh woman so she focuses on the technique versus the pain/contractions


Why do we provide for pain/discomfort management?

Tense muscles causes: -inhibition of fetal descent -maternal fatique (mom needs to conserve her energy for pushing)


Non-pharmacologic interventions for relaxation

-massage -effleurage -hydrotherapy (warm water best) -position changes -hypnosis -aromatherapy -rocking/gliding -birthing ball -prayer/ mediation -leaning against bed/partner -visualization -relaxation techniques -breathing techniques -w


Why do guided imagery techniques work so well?

because beliefs we "create" in our mind are just as powerful whether they were real or imagined when one is deeply relaxed and in an altered, dream like state, ones mind is more receptive to intuition, learning, healing, creativity, and performanc


What is guided imagery?

Use of all senses (sight, touch, taste, smell, and hearing) to promote relaxation. Smell is limited depending on what is allowed for oral input. WHEN ADDING DEEP EMOTIONS AND FEELINGS, THE VISUALIZATION PROCESS BECOMES SUPERCHARGED


Pros of walking during labor

-increases pateints comfort level -aids in fetal descent -naturally stimulates contractions *most women can walk from 0-10 cm dilation


Cons of walking during labor

-expend used of energy -hard for women to do because of pain (contractions)


Contraindications for walking during labor

-vaginal bleeding -ruptured membrane BEFORE fetus engaged in pelvis (fetus must be at least 0 station) *if baladable their head is not in the pelvis and we do not want them walking.


Comfort measures to use when patient is in bed. (4)

-side lying position -frequent position changes -pillows and blankets for body support (knees, back, under uterus) -if mom wants to be on back make sure head of bed is raised so she is in sitting position keeping the weight of the uterus off the v


Interventions for patients who are expereincing diaphoresis and leakage of amniotic fluid?

-change bed linins and pads frequently -provide perineal care -cool wash cloth to face


Nursing interventions for patients coming in with anxiety

-establish rapport -express confidence in couples ability to get thru process -lsiten to patient to find out pain management, goals, and plan -praise patietn as offten as possible -observe for signs of coping problems or discomfort & offer advice


common cause of back pain in laboring mothers

fetal head is in a posterior position -right occiput position -left occiput position -occiput position


Interventions for patients experiencing back pain

-birthing ball -apply pressure to lower back/scaral region -warm towel/blanket -alternate btwn warm towel and ice pack -move positions


What is most important concerning breathing techniques (2)

-find what works best for the patient -ALWAYS begin with cleansing breath


What is a cleansing breath? (CB)

-inhale through the nose -hold breath for few seconds -exhale through the lips


Level I, II, and II breathing techniques are referred to as?

-Slow deep relaxed breathing -Shallow/modified paced breathing -pant & blow or pattern paced breathing


Level I Slow Deep Relaxed breathing

-begin w/ cleansing breath -chest breathing technique only -6-9 breaths/min -ends with CB


Level II Shallow/ Modified Paced Breathing

-Used in more active labor -begins w/ CB -inhale and exhale at a rate of 4 breats every 5 seconds -** Do not exceed 2-2 1/2 breaths per sec -end with CB


Level III Pant & Blow or Pattern Breathing

-Used during Transition phase -begin with CB -he-he-he -do not exceed 2 - 2 1/2 breats per sec -end with CB


When and why is level III breathing used?

pant and blow breathting is used in TRANSITION phase of labor -rectal pressure -not completely dilated -dont want her to push yet


Theory behind abdominal breathing?

As the woman inhales, the abdominal wall is lifted off the uterus and helps provide PAIN RELIEF


How is abdomainal breathing performed?

-woman moves abdomen outward during inhalation -moves abdomen inward during exhalation -6-9 breaths/min (same as level I)


Patho for hyperventilation

Cause: imbalance of O2 and Co2 -too much oxygen -too little Co2


Signs and symptoms of hyperventilation

-tingling or numbness in the tip of nose, fingers, or toes -dizziness, spots before the eyes, hand


What should the nurse have the patient do if she is hyperventilation?

-breath into a bag or surgical mask -slow breathing with shallow breaths *trying to increase Co2 levels


What information is needed to be explained to the support person regarding hyperventilation?

explain to the support person that once the patient maintaines normal braething, we need to monitor her because we do not want her breathing quickly again.


Additional comfort measures taken in stage 2 of labor dud to patient working extremely hard in pushing process.

-coolc ompress to face and forehead -chagne bed linens (diaphoresis) -rest between contractions -sips of fluids (ice chips) -positive re-enforcement


What is passive descent (laboring down)?

A woman delays pushing until she feels the urge to push or until the fetal head is visible.


Why may a patient use passive descent?

-10 cm dilated -rectal pressure but no urge to push yet


Pros of passive descent (laboring down)?

-increases chance of SVD (spontaneous vaginal delivery) -decreases risk of instrument-assisted delivery -decreases pushing time * Does not lengthen stage 2 labor


passive descent vs. active pushing: MATERNAL OUTCOMES

-no difference in rate of cesarean births -no difference in rate of lacterations of episiotomies


passive descent vs. active pushing: FETAL OUTCOMES

-WITH ACTIVE PUSHING: increased rates of fetal o2 de-saturation levels


recommendtations for passive descent (laboring down)

-allow woman 2 hours for passive descent before beginning active pushing -need to vaginal exam (VE) one hour to assess for arrest of labor -make sure no fetal <3 compromise (no decelerations)


lithotomy birthing position

-using stirrups -patient lying on back ** avoid as much as possible, do not want to do this!! *wt of fetus crushes vena cava


Up-right birthing positions

-kneeling -squatting -standing -sitting


What women need to know about pain relief medications. (5)

-type of med -route -expected effects of med -implications for fetus or newborn -safety measures needed (ex: remain in bed w/ side rails up)


Effects of pain on the Mother

-increase HR, b/p, rr, pulse -tense muscles during contractions--> exhaustion -increase o2 consumption -maternal blood vessels constriction caused by release of catecholamines (leading to metabolic acidosis)


Effects of pain on the fetus

-decreased oxygen and nutrients transport -can lead to FHR decelerations