Nursing Management of Pain During Labor and Birth

Nursing Management of Pain During Labor and Birth A nurse is teaching a childbirth preparation class. The group is discussing individual expression of labor pain. What statement is accurate about a patient's expression of pain? a. It reduces the patient's 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? a. Endorphins b. Morphine c. Codeine d. Atropine 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 woman's labor coach to comfort her by firmly pressing on her lower back. What is this technique? a. Sacral pressure b. Distraction c. Effleurage 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? a. Hypertension b. Anxiety c. Anoxia d. Hyperventilation 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. 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. - ANS: B 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. 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 - ANS: B 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 - ANS: D A side effect of an epidural block is urine retention because the anesthesia interferes with the woman's ability to have an urge to void. The patient may have to be catheterized. 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. - ANS: D 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. "I'm having a contraction. Can I get the pudendal block now?" b. "I'll 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." - ANS: A 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 can't 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 - ANS: A 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 d. Massage - ANS: D 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 - ANS: A An epidural block is not used if a woman has abnormal blood clotting. 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 - ANS: B Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix. 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 - ANS: B 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 patient's rate while performing slow breathing? a. 9 b. 11 c. 15 d. 20 - ANS: B 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? a. Tolerance b. Threshold c. Level d. Abatement - ANS: B 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 - ANS: B 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 nurse's 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. - ANS: D ................