Maternal - Neonatal Nursing Lecture Notes

Pain Management Pain During Labor and Birth • Neurologic origins • • • Visceral pain: from cervical changes, distention of lower uterine segment, and uterine ischemia Located over lower portion of abdomen • Referred pain originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs Pain During Labor and Birth (Cont.) Neurologic origins • Somatic pain: pain described as intense, sharp, burning, and localized • Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions and lacerations of soft tissue Pain During Labor and Birth (Cont.) • First stage of labor • Visceral pain Second stage of labor • Somatic pain Third stage of labor • Similar to the first stage • • – Pain During Labor and Birth (Cont.) • Perception of pain • • • • Threshold remarkably similar in all, regardless of gender, social, ethnic, or cultural differences Differences play definite role in person’s perception of and behavioral responses to pain Pain tolerance refers to the level of pain a woman is willing to endure Pain During Labor and Birth (Cont.) Expression of pain • • Pain results in physiologic effects and sensory and emotional (affective) responses Emotional expressions of suffering often seen • Increasing anxiety • Writhing, crying, groaning, gesturing (hand clenching and wringing), and excessive muscular excitability • • Factors influencing pain response • • • • • • • • • • • Cultural expression of pain varies Pain During Labor and Birth (Cont.) Physiologic factors Culture Anxiety Previous experience Gate-control theory of pain Comfort and support Environment Nonpharmacologic Pain Management Nonpharmacologic measures often simple, safe, few adverse reactions, and inexpensive Provide sense of control over childbirth Methods require practice for best results Try variety of methods and seek alternatives, including pharmacologic methods, if measure used is not effective Nonpharmacologic Pain Management (Cont.) • • • • • • Alternative therapies • • • • • • Relaxation Imagery and visualization Breathing techniques Effleurage and counterpressure Touch and massage Applications of heat and cold Nonpharmacologic Pain Management (Cont.) Alternative therapies • • • • Transcutaneous electrical nerve stimulation Water therapy (hydrotherapy) Aromatherapy Music Pharmacologic Pain Management • Should be implemented before pain becomes so severe that catecholamines increase and labor is prolonged • Combinations of pharmacologic and nonpharmacologic measures increased pain relief and create a more positive birth experience • Pharmacologic Pain Management (Cont.) • • Sedatives Analgesia and anesthesia • • • Nerve block analgesia and anesthesia • • • – Anesthesia Systemic analgesia • Opioid (narcotic) agonist analgesics • Opioid (narcotic) agonist–antagonist analgesics • Opioid (narcotic) antagonists Pharmacologic Pain Management (Cont.) • • • • • • Local perineal infiltration anesthesia Pudendal nerve block Spinal anesthesia (block) • Disadvantages • Marked hypotension • Impaired placental perfusion • Ineffective breathing patterns • Headache Pharmacologic Pain Management (Cont.) Epidural Anesthesia Combined spinal-epidural analgesia Epidural effects on newborn Nursing Management of care Nitrous oxide for analgesia General Anesthesia Pharmacologic Pain Management (Cont.) • Nerve block analgesia and anesthesia anesthesia/analgesia • EpiduralPositioning • Difficulty if patient is obese • Disadvantages • spinal/epidural anesthesia • Combined Walking epidural • • Epidural and intrathecal opioids • • Pharmacologic Pain Management (Cont.) Nerve block analgesia and anesthesia • Contraindications to epidural blocks • Hemorrhage • Hypotension • Coagulopathy • Infection at injection site • • • • • • Used rarely for vaginal births Infrequently for elective cesarean section May be necessary if indications necessitate a rapid birth Care Management Plan of care and implementation • • • • • Epidural anesthesia/analgesia effects on the newborn • Little or no lasting effects Nitrous oxide • Used extensively in other countries • Getting popularity in the United States as an alternative • Self-administered Pharmacologic Pain Management (Cont.) General anesthesia • • • • Pharmacologic Pain Management (Cont.) Nerve block analgesia and anesthesia • • Allergy to anesthetic drug Maternal refusal or inability to cooperate Maternal cardiac conditions Nonpharmacologic interventions Informed consent Timing of administration Preparation for procedures Care Management (Cont.) Plan of care and implementation • • Administration of medication • Intravenous route • Intramuscular route • Regional Safety and general care • Anesthesia in obese woman • Allergic reactions • Adverse events Question The most important nursing intervention after the injection of epidural anesthesia is monitoring: 1.urinary output. 2.contractions. 3.maternal blood pressure. 4.intravenous infusion rate.