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Chapter 7 Nursing management of pain during labor and birth
Terms in this set (36)
A nurse is teaching a childbirth preparation class. The group is discussing individual expression of labor pain. What statement is accurate about a patients expression of pain?
a. It reduces the patients perception of pain.
b. It is intensified by the vertex position of the fetus.
c. It is influenced by culture.
d. It can be completely controlled by nonpharmacological techniques.
Culture influences how women feel about birth and what is an acceptable response to pain.
What chemical substance(s) produced in the body acts as a natural pain reliever?
Endorphins are natural body substances that are similar to morphine and may explain why laboring women need smaller doses of analgesia.
A nurse instructs a womans labor coach to comfort her by firmly pressing on her lower back. What is this technique?
a. Sacral pressure
d. Conscious relaxation
Sacral pressure refers to firm pressure against the lower back to relieve some of the pain of back labor
A woman who is 6 cm dilated has the urge to push. What will the nurse instruct the woman to do during the contraction?
a. Use slow-paced breathing.
b. Hold her breath and push.
c. Blow in short breaths.
d. Use rapid-paced breathing.
If a laboring woman feels the urge to push before the cervix is fully dilated, then she is taught to blow in short breaths to avoid bearing down.
Several hours into labor, a woman complains of dizziness, numbness, and tingling of her hands and mouth. What does the nurse recognize these symptoms signify?
Hyperventilation is sometimes a problem if a woman is breathing rapidly
What is the most appropriate nursing action to take when a laboring woman hyperventilates?
a. Help her breathe into her cupped hands.
b. Place her flat on her back.
c. Initiate oxygen at 2 liters via mask.
d. Notify the doctor.
Measures to combat hyperventilation include breathing into cupped hands or a paper bag or holding breath for a few seconds. All of these techniques decrease PCO2.
A woman in the transition phase of labor requests a narcotic analgesic medication for pain relief. What should the nurse explain regarding giving a narcotic analgesic medication at this stage of labor?
a. It can cause medication given at later stages to be ineffective.
b. It will have no complications for the mother or infant.
c. It may result in respiratory depression to the newborn.
d. It will speed up labor and increase pain.
The risk of narcotic analgesics is that they cross the placenta and can cause fetal respiratory depression.
What would the nurse guide a labor coach to do to comfort a woman tensing her muscles with contractions?
a. Offer warm liquids to the patient.
b. Encourage the patient to pant.
c. Engage the patient in conversation.
d. Assist the patient to the knee-chest position.
Panting relaxes the abdominal wall and distracts the patient. It would not be helpful to offer fluids or to attempt conversation during contractions. Walking intensifies contractions.
A woman in labor will receive general anesthesia prior to cesarean section. The nurse reminds the patient that food and fluids need to be restricted for several hours prior to delivery. What will this prevent?
a. Nausea and vomiting
b. Vomiting and aspiration
c. Abdominal cramping
d. Intestinal obstruction
The major adverse effect of general anesthesia is aspiration of stomach contents.
What assessment should be taken immediately after the anesthesiologist administers an epidural block to a laboring woman?
a. Bladder for distention
b. Blood pressure
c. Sensation in the lower extremities
d. Intravenous fluid flow rate
Blood pressure is checked every 5 minutes when the epidural block is first begun. Bladder assessment is also important but not an initial assessment.
A woman in labor has had an epidural block for pain relief. The nurse will be assessing carefully for what associated side effect of this type of regional anesthesia?
a. Reduced fetal heart rate
b. Long, intense contractions
c. Sudden leg cramps
d. Bladder distention
A side effect of an epidural block is urine retention because the anesthesia interferes with the womans ability to have an urge to void. The patient may have to be catheterized.
Which narcotic antagonist is used to reverse narcotic-induced respiratory depression?
a. Hydroxyzine (Vistaril)
c. Naloxone (Narcan)
d. Nitrous oxide
Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics.
The nurse is preparing a teaching plan for a woman receiving a subarachnoid block before delivery. What nursing action will be included in this plan to prevent the associated side effect of this type of anesthesia?
a. Restrict oral fluids.
b. Keep legs flexed.
c. Walk with assistance as soon as possible.
d. Lie flat for several hours.
The woman would be advised to remain flat for several hours after the block to decrease the chance of postspinal headache.
A woman requests a pudendal block to manage her labor pain. What statement by the woman indicates a need for further explanation about the pudendal block?
a. Im having a contraction. Can I get the pudendal block now?
b. Ill get the pudendal block right before I deliver.
c. The nurse midwife will insert the needles into my vagina.
d. It takes a few minutes after the medicine is administered to make me feel numb.
The pudendal block does not block pain from contractions and is given just before birth.
An 18-year-old primigravida is 4 cm dilated and her contractions are 5 minutes apart. She received little prenatal care and had no childbirth preparation. She is crying loudly and shouting, Please give me something for the pain. I cant take the pain! What is the priority nursing diagnosis?
a. Pain related to uterine contractions
b. Knowledge deficit related to the birth experience
c. Ineffective coping related to inadequate preparation for labor
d. Risk for injury related to lack of prenatal care
The most important issue for this woman, at this time, is effective pain management.
The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management?
a. Slow abdominal breathing
b. Guided relaxation
c. Listening to music
According to the gate control theory, stimulating large-diameter nerve fibers temporarily interferes with conduction of impulses through small-diameter fibers. Massage is a technique that stimulates large-diameter fibers and closes the gate.
When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an epidural for delivery. What is a contraindication to an epidural block?
a. Abnormal clotting
b. Previous cesarean delivery
c. History of migraine headaches
d. History of diabetes mellitus
An epidural block is not used if a woman has abnormal blood clotting.
The ______________ ___________, also called the psychoprophylactic method, is the basis of most childbirth preparation classes in the United States.
The Lamaze method, also called the psychoprophylactic method, is the basis of most childbirth preparation classes in the United States.
What is the Dick-Read method of childbirth preparation based on?
a. Mild sedation throughout labor
b. Relaxation techniques
c. Skin stimulation
d. Deep massage
The Dick-Read method depends on the use of relaxation techniques to reduce the discomforts of labor.
The nurse is instructing a Lamaze class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths per minute. What should be the patients rate while performing slow breathing?
The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate.
What is the least amount of sensation that one perceives as pain?
Pain threshold is the least amount of sensation that one perceives as pain. Thresholds are different for each individual.
The nurse is caring for a laboring patient who is not reporting pain. What sign would alert the nurse of the need for pain relief?
a. Frequently asking for ice chips
b. Facial grimacing
c. Changing positions in bed
d. Covering her face with her hands
Facial grimacing may be an indicator of unexpressed pain.
A patient who received an epidural block asks why her blood pressure is taken so often. What is the nurses best response to explain the frequent blood pressure assessments?
a. They ensure that unsafe levels of hypertension do not occur.
b. They help assess for the need for further pain relief.
c. They monitor the progress of labor.
d. They ensure adequate placental perfusion.
The hypotension that accompanies an epidural block may cause inadequate perfusion of the placenta, leading to fetal hypoxia.
A laboring patient requests hot and cold applications be applied to her abdomen for pain control. How will this intervention act to control pain?
a. By increasing endorphin production
b. By facilitating effacement and dilation
c. By producing increasing pain tolerance
d. By stimulation of large nerve fibers
The gate control theory explains how pain impulses reach the brain for interpretation. It supports several nonpharmacological methods of pain control. According to this theory, pain is transmitted through small-diameter nerve fibers. However, the stimulation of large-diameter nerve fibers temporarily interferes with the conduction of impulses through small-diameter fibers. Techniques to stimulate large-diameter fibers and close the gate to painful impulses include massage, palm and fingertip pressure, and heat and cold applications.
When caring for the laboring patient, the nurse determines that the fetus is located in the right occiput posterior (ROA). What will the nurse anticipate?
a. Urinary retention
b. Severe lower back pain
c. A shorter labor process
If the fetal occiput is in a posterior pelvic quadrant, each contraction pushes it against the mothers sacrum, resulting in persistent and poorly relieved back pain (back labor). Labor is often longer with this fetal position.
What typical types of classes are available to help expectant parents prepare for parenthood? (Select all that apply.)
a. Infant care
c. Gestational diabetes
d. Sources of financial aid
ANS: A, B, C
Prenatal classes include such topics as infant care, breastfeeding, gestational diabetes, exercising, and sibling and grandparent preparation. Yoga and financial information are not traditional content for prenatal instruction.
What breathing techniques would the nurse teach the prenatal patient to help her focus during labor in order to reduce pain? (Select all that apply.)
a. First stage breathing
b. Abdominal breathing
c. Fourth stage breathing
d. Modified pace breathing
e. Patterned paced breathing
ANS: A, B, D, E
First stage breathing includes the techniques of modified pace breathing and patterned paced breathing, which are types of abdominal breathing techniques. These patterns of breathing will help a woman in labor to focus and reduce pain perception. The fourth stage of labor is the womans recovery stage and does not require a breathing technique.
How does the pain of childbirth differ from other types of pain? (Select all that apply.)
a. Childbirth pain is part of a normal process.
b. Childbirth pain seldom needs narcotic relief.
c. Position changes relieve pain and facilitate delivery.
d. Childbirth pain declines following birth.
e. Childbirth pain is self-limited.
ANS: A, C, D, E
Childbirth pain differs from other types of pain because it is part of a normal, natural, and expected process, can be relieved by change of position, declines immediately following birth, and is self-limiting. Childbirth pain requires pharmacological management with narcotics in many cases.
Which are nonpharmacological forms of pain relief? (Select all that apply.)
a. Skin stimulation
b. Diversion and distraction
c. Breathing techniques
ANS: A, B, C
Skin stimulation, diversion and distraction, and breathing techniques are the bases of nonpharmacological pain control. Although exercise and practices such as yoga and Pilates are beneficial, they are not means of pain control.
Which position(s) and exercise(s) will the nurse teach as beneficial in combating discomfort in the later stages of pregnancy? (Select all that apply.)
a. Leg lifts
b. Pelvic rock
c. Tailor sitting
e. Shoulder curling
ANS: B, C, E
Pelvic rock, tailor sitting, and shoulder curling are beneficial to the muscles that will have to adapt to the extra weight and changed posture of later pregnancy. Leg lifts and sit-ups are not beneficial because they both increase intraabdominal pressure.
The nurse is providing a conference on nonpharmacological pain control methods. What major advantages of nonpharmacological pain control methods will the nurse include in the presentation? (Select all that apply.)
a. They sedate the mother.
b. They do not slow labor.
c. They do not dull the excitement of the birth experience.
d. They do not have the potential to cause allergic reactions.
e. They do not have to be delayed until labor is well established.
ANS: B, C, D, E
All the options mentioned are benefits of nonpharmacological pain control methods with the exception of sedating the mother.
The nurse is caring for a woman with epidural anesthesia for pain control during a vaginal delivery. A risk for injury related to epidural anesthesia has been identified by the nursing staff. What interventions are appropriate for the nurse to implement related to this diagnosis? (Select all that apply.)
a. Assess leg movement and sensation before ambulating.
b. Administer antibiotic as ordered.
c. Observe for signs of impending birth.
d. Provide sacral pressure as needed.
e. Assess fetal position frequently.
ANS: A, C
To prevent the risk for injury related to epidural anesthesia the nurse should asses for movement, sensation, and leg strength before ambulating, ambulate cautiously with an assistant, assist the woman to change positions regularly, and observe for signs that birth may be near: increase in bloody show, perineal bulging, and/or crowning.
The physician has ordered Fentanyl (Sublimaze) for a woman in labor and has asked the nurse to provide patient education. What will the nurse include in the educational plan? (Select all that apply.)
a. Onset is slow.
b. Duration is short.
c. Administration is by mouth.
d. No known side effects.
e. It is not the same drug as sufentanil.
ANS: B, E
Fentanyl has a rapid onset and short duration of action. Fentanyl, sufentanil, and alfentanil are not the same drugs. Fentanyl can cause respiratory depression but less than meperidine. It is not administered by mouth.
The nurse coaches the primigravida not to bear down until the cervix is completely dilated. What may premature bearing down cause?
a. Increased use of oxygen
b. Cervical laceration
c. Uterine rupture
d. Compression of the cord
Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix.
The massage technique that stimulates the large-diameter fibers in order to block impulses from the small-diameter fibers is ____________________.
Effleurage stimulates the large-diameter fibers and blocks the pain impulses from the small-diameter fibers.
The amount of pain a person is willing to endure is referred to as ______________ ______________.
Pain tolerance is the amount of pain a person is willing to endure. Pain threshold is the point at which pain is perceived. Pain threshold is relatively consistent from person to person, but pain tolerance differs greatly.
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