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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
-pain -uncomfortable position -infrequent position changes -diaphoresis -leaking of amniotic fluid after rupture -dry mouth -anxiety -fear
-less intense and frequent contractions -aware of environment -talkative -does not mind being touched -can follow directions and focus
-contractions more frequent and intense -less aware of environment -less talkative -may not want to be touched -cannot follow directions and can't focus
-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
-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.
-relax tense muscles -distract teh woman so she focuses on the technique versus the pain/contractions
Tense muscles causes: -inhibition of fetal descent -maternal fatique (mom needs to conserve her energy for pushing)
-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
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
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
-increases pateints comfort level -aids in fetal descent -naturally stimulates contractions *most women can walk from 0-10 cm dilation
-expend used of energy -hard for women to do because of pain (contractions)
-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.
-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
-left lateral tilt or high fowlers position
developing skin irritations
-change bed linins and pads frequently -provide perineal care -cool wash cloth to face
-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
fetal head is in a posterior position -right occiput position -left occiput position -occiput position
-birthing ball -apply pressure to lower back/scaral region -warm towel/blanket -alternate btwn warm towel and ice pack -move positions
-find what works best for the patient -ALWAYS begin with cleansing breath
-inhale through the nose -hold breath for few seconds -exhale through the lips
-Slow deep relaxed breathing -Shallow/modified paced breathing -pant & blow or pattern paced breathing
-begin w/ cleansing breath -chest breathing technique only -6-9 breaths/min -ends with CB
-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
-Used during Transition phase -begin with CB -he-he-he -do not exceed 2 - 2 1/2 breats per sec -end with CB
pant and blow breathting is used in TRANSITION phase of labor -rectal pressure -not completely dilated -dont want her to push yet
-deep breathing -early and active labor
As the woman inhales, the abdominal wall is lifted off the uterus and helps provide PAIN RELIEF
-woman moves abdomen outward during inhalation -moves abdomen inward during exhalation -6-9 breaths/min (same as level I)
Cause: imbalance of O2 and Co2 -too much oxygen -too little Co2
-tingling or numbness in the tip of nose, fingers, or toes -dizziness, spots before the eyes, hand
-breath into a bag or surgical mask -slow breathing with shallow breaths *trying to increase Co2 levels
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
A woman delays pushing until she feels the urge to push or until the fetal head is visible.
-10 cm dilated -rectal pressure but no urge to push yet
-increases chance of SVD (spontaneous vaginal delivery) -decreases risk of instrument-assisted delivery -decreases pushing time * Does not lengthen stage 2 labor
-no difference in rate of cesarean births -no difference in rate of lacterations of episiotomies
-WITH ACTIVE PUSHING: increased rates of fetal o2 de-saturation levels
-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)
-using stirrups -patient lying on back ** avoid as much as possible, do not want to do this!! *wt of fetus crushes vena cava
-kneeling -squatting -standing -sitting
-type of med -route -expected effects of med -implications for fetus or newborn -safety measures needed (ex: remain in bed w/ side rails up)
-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)
-decreased oxygen and nutrients transport -can lead to FHR decelerations
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