Chapter 7 spring 2004 lecture notes

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Chapter 7 spring 2004 lecture notes Powered By Docstoc
					Chapter 7
Nursing Management of Pain During Labor and Birth
Factors that Influence labor Pain
   Pain threshold
    – pain perception
    – Least amount of sensation a person perceives as painful
    – Fairly constant
   Pain tolerance
    – Amount willing to endure

Sources of Pain during Labor
   Dilation and stretching of cervix
   Reduced blood supply during contraction
   Pressure of fetus on pelvis
   Stretching of vagina and perineum
Physical factors that Modify Pain
   Gate control theory
   Endorphins
   Maternal condition
   Fetal presentation and position
Nonpharmacological Pain Management
   Relaxation techniques
   Skin stimulation
   Positioning
   Diversion/distraction
   Imagery
   Breathing techniques
Breathing Techniques
   Each breathing pattern begins and ends with a cleansing breath
   First-stage breathing
     – Slow-paced breathing
     – Modified-paced breathing
     – Patterned-paced breathing
   Second-stage breathing
Pharmacological Pain Management
   Analgesics and adjunctive drugs
   Regional analgesics and anesthetics
     – Local infiltration
     – Pudendal block
     – Epidural block
     – Subarachnoid block (spinal block)
   General anesthesia
Regional anesthesia

Pudendal Block
Adverse Effects of Pharmacological Methods
   Systemic opioid
     – Fetal respiratory depression
   Pudendal block
     – Vaginal hematoma
   Epidural and subarachnoid block (spinal block)
     – Maternal hypotension and urinary retention
     – Spinal headache with subarachnoid block
   General anesthesia
     – Maternal: aspiration of stomach contents
     – Fetus: respiratory depression

Nurses Role
   Admission – questions allergies
   Side rails
   Hypotension from epidural- bolus 500-1000 before
   Positioning
   Narcotics – respiratory depression
Duramorph
   Morphine derivative
   Nursing care
   O2 sat monitor
   Respiratory rate
   No narcotics 24 hours after
   Check orders for protocol

				
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