L & D Pain Management - ATI CH 12

L & D Pain Management - ATI CH 12 Pain mgt. during L&D - Pain is a subjective and individual experience, and each client's response to the pain of labor is unique. Sources of pain during the FIRST STAGE of labor - ◯ First stage - internal visceral pain that may be felt as back and leg pain, which is caused by ■ Dilation, effacement, and stretching of the cervix ■ Distention of the lower segment of the uterus ■ Contractions of the uterus with resultant uterine ischemia Sources of pain during the SECOND STAGE of labor - ◯ Second stage - pain that is somatic and occurs with fetal descent and expulsion. Pain is caused by ■ Pressure and distention of the vagina and the perineum, described by the client as "burning, splitting, and tearing" ■ Pressure and pulling on the pelvic structures (ligaments, fallopian tubes, ovaries, bladder, and peritoneum) ■ Lacerations of soft tissues (cervix, vagina, and perineum) Sources of pain during the THIRD STAGE of labor - ◯ Third stage - pain with the expulsion of the placenta is similar to the pain experienced during the first stage. Pain is caused by ■ Uterine contractions ■ Pressure and pulling of pelvic structures Sources of pain during the FORTH STAGE of labor - ◯ Fourth stage - pain is caused by ■ Distention and stretching of the vagina and perineum incurred during the second stage with a splitting, burning, and tearing sensation What is the first consideration of the nurse when planning pain management measures? - Safety for the mother and fetus What can affect the way a woman experiences pain during L&D? - Anxiety Cultural beliefs Birth plan beliefs and expectations Fear Fatigue Full bladder Individual pain tolerance Previous experiences with pain Fetal malposition Cephalopelvic disproportion Childbirth preparation Level of support during labor How do anxiety and fear affect pain management? - As fear and anxiety increase, muscle tension increases, and thus the experience of pain increases, becoming a cycle of pain. What should the nurse assess when developing the client's pain management care plan? - ● Assess the beliefs and expectations related to discomfort, pain relief, and birth plans regarding pain relief methods of the client who is in labor. ● Assess the client's level, quality, frequency, duration, intensity, and location of pain through verbal and nonverbal cues. Other indications of pain - ■ Behavioral manifestations such as crying, moaning, screaming, gesturing, writhing, avoidance or withdrawal, and inability to follow instructions ■ Increasing blood pressure, tachycardia, and hyperventilation What are the nurse's responsibilities regarding pain management in L&D? - ● helping the client maintain the proper position during administration of pharmacological interventions. ● assisting the client with positioning for comfort during labor and birth ● client safety after any pharmacological intervention ● Evaluate the client's response to pain relief methods used (verbal report that pain is relieved or being relieved, appears relaxed between contractions). Nonpharmacological pain management - ● Nonpharmacological pain management measures reduce anxiety, fear, and tension, which are major contributing factors to pain in labor. Gate-control theory ...................