Sherpath Lesson: Chapter 13 Pain Management During Childbirth Nonpharmacologic Methods of Pain Relief (wk 3)

3. Massage

a. Effleurage (self massage)- rub her own abdomen, legs, or back b. partner can rub woman's back, shoulders, legs c. Non clinical touch- holding pt hand, stroking her hair

2. Breathing techniques

a. Slow Paced b. Modified Paced c. Patter P

1. Relaxation techniques

a. imagery b. focal points c. music

What methods of breathing can be used during a contraction?

-combination of slow and modified pace -begin slowly and use shallow, faster breathing at the peak of the contraction -should not interfere with relaxation but enhance it

2. Somatic pain

-occurs when pain receptors in tissues are activated -general characteristic a. intense b. sharp c. burning d. well localized -occurs from stretching and distention of the perineal tissues and the pelvic floor to allow for passage of the fetus, from distention and traction on the peritoneum and uterocervical supports during contractions, and from lacerations of soft tissue during and after the birth

1. Visceral

-results from the activation of nociceptors in the thoracic, abdominal, and pelvic areas -typically manifests in labor as referred pain caused by the stretching and inflammation of superficial structures -General characteristics: a. Increased HR & RR b. sensitization of somatic tissues c. strong affective responses. -occurs when there is distention of the lower uterine segment during effacement of the cervix, stretching of cervical tissues as it dilates, and pressure on adjacent structures and nerves during the first stage of labor when the fetus is entering the birth canal

Which statement regarding pain experienced during labor is accurate? A. The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. B. Referred pain is the extreme discomfort between contractions. C. The somatic pain of the second stage of labor is more generalized and related to fatigue. D. Pain during the third stage is a somewhat milder version of the second stage.

A

A laboring woman is attempting an unmedicated birth and asks the nurse to hold her hand during contractions. Which relaxation technique is the nurse performing?A. Imagery B. Focal point C. Acupressure D. Massage

D.

Nonpharmacological method of pain relief in labor

1. Relaxation techniques 2. Breathing techniques 3. Massage 4. Thermal Stimulation 5. Acupressure & Acupuncture 6. Hydrotherapy

2 Primary sources of physiological pain in labor

1. Visceral 2. Somatic

c. Pattern paced

1. aka pant blow, hee hoo, hee blow 2. focusing on a rhythmic pattern of breathing 3. differs from modified in that after a certain # of breaths, the woman exhales with a slight emphasis or blow & then begins the modified-paced breathing again 4. addition of a blow: a. causes her to focus more on her breathing b. reduces habituation

Psychological expressions of pain in labor

1. anxiety 2. crying 3. groaning 4. irritability 5. writhing 6. clenching of hands or face

a. Slow paced

1. as long as possible during labor because it promotes relaxation & sufficient oxygenation 2. 1/2 of normal breathing rate but no less than 1/2 or more rapid than 2x the base rate 3. focus is on release of tension rather than on the actual number of breaths taken.

Environmental factors r/t pain

1. support person or people present 2. physical environment (availability of birthing ball, comfortable chairs, etc.) 3. place of birth (home, birth center, hospital, etc.) 4. laboring woman's comfort with her HCP's 5. bringing comfort items from home (pictures, pillows, pj's, music, movies, objects to focus on)

b. Modified Paced

1. used when slow paced is no longer effective 2. shallower 3. faster rate allows for sufficient oxygenation (same as slow paced) 4. focus is on release of tension rather than on the actual number of breaths taken.

A laboring woman's partner has become fatigued after massaging the woman's legs for the past 30 minutes. Which action would the nurse take first? A. Ask the woman if it is OK for the nurse to take over massaging her legs. B. Tell the support person to stop because it's not helpful anymore. C. Grasp the woman's hand and stroke it gently. D. Prepare equipment for acupuncture.

A

A woman is experiencing back labor and complains of intense pain in her lower back. The nurse instructs the support person to use which nonpharmacologic technique? A. Counterpressure against the sacrum B. Slow-paced breathing techniques C. Effleurage D. Conscious relaxation or guided imagery

A

A laboring patient reports moderate back pain. Her partner rubs her lower back and reminds her to look at the teddy bear they bought for the newborn. Which relaxation techniques are being used? Select all that apply. A. Massage B. Focal point C. Hydrotherapy D. Acupressure E. Mental imagery

A, B

Which examples demonstrate how labor pain differs from other types of pain? Select all that apply. A. Labor pain is intermittent. B. Labor pain has a foreseeable end. C. Childbirth pain is part of a normal process. D. Women can acquire skills to help manage labor pain. E. Labor pain is intensified by the emotional component of delivering an infant.

A, B, C, D

When teaching a childbirth class for first-time parents, the nurse includes which benefits of breathing techniques used during labor? Select all that apply. A. Decreases sensation of pain B. Requires increased energy with continued use C. Provides a different focus during contractions D. Can also substitute for pharmacologic therapies E. Can be used with other nonpharmacologic techniques

A, C, D, E

Which factors could improve a woman's experience with pain during labor? Select all that apply. A. Cultural factors B. Financial factors C. Environmental factors D. Psychological factors E. Physiologic factors

A, C, D, E

The nurse is caring for a woman in the second stage of labor whose contractions have become more intense. What actions could the nurse take to assist this woman? Select all that apply. A. Model modified-paced breathing. B. Model slow-paced breathing. C. Monitor for hyperventilation. D. Conduct acupuncture. E. Ask the patient if it is OK to hold her hand.

A, C, E

A woman is experiencing intense pain with each contraction during labor. Her partner asks her to describe in detail her favorite beach. Which relaxation technique is her partner using? A. Imagery B. Focal point C. Acupressure D. Thermal stimulation

A.

5. Acupressure & Acupuncture

Acupressure: directed form of massage in which the support person applies pressure to specific pressure points using hands, rollers, balls, or other equipment Acupuncture: thin needles are inserted into the body

The nurse is instructing a childbirth class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths/min. What should the patient's rate be while performing slow-paced breathing techniques? A. 9 breaths/min B. 11 breaths/min C. 15 breaths/min D. 20 breaths/min

B

A laboring woman wishes to labor in the shower to alleviate pain. Which nonpharmacologic pain relief method is she applying? A. Massage B. Acupressure C. Hydrotherapy D. Relaxation

C

6. Hydrotherapy

Contraindications: a. thick meconium in the amniotic fluid b. bleeding c. oxytocin use-requires continuous fetal monitoring

Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information would the nurse consider when educating patients and support people about nonpharmacologic pain management techniques? A. Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine. B. Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time. C. Effleurage is permissible, but counterpressure is almost always counterproductive. D. Acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain.

D

Several hours into an unmedicated labor, a woman complains of lightheadedness and anxiety. The nurse assists the woman with patterned breathing techniques to address which condition? A. Hypertension B. Heart attack C. Preeclampsia D. Hyperventilation

D

Which physiologic effect results from labor pain? A. Decreased metabolic rate B. Increased uterine blood flow C. Decreased maternal demand for oxygen D. Increased production of catecholamines

D

Which situation demonstrates how an environmental factor could negatively affect a woman's experience of pain during labor? A. The woman experienced tearing of the perineum during delivery. B. The woman had a complicated delivery with her previous child. C. The woman's family views vocalizing about pain as "complaining." D. The woman has no support at her bedside.

D

Which event results in a somatic pain response during labor? A. Effacement of the cervix during early labor B. Dilation of the cervix during labor C. Bladder pressure D. Delivery of the fetal head

D-Delivery of the fetal head causes the perineum to stretch. Delivery of the fetal head results in a somatic pain response caused by the burning experienced at the perineum during the delivery of the fetal head. A, B, C- visceral pain

A laboring patient places a cool, damp compress over her forehead. This is an example of which nonpharmacologic method of pain relief? A. Massage B. Acupressure C. Hydrotherapy D. Thermal stimulation

D.

PAIN

P- purposeful (in order to birth the baby) A- anticipated (labor is not a pain-free experience) I- intermittent (contractions come and go as labor progresses) N- normal (labor is not a pain-free experience)

4. Thermal stimulation

a. warmth applied to their back, abdomen, or perineum during labor -warm shower -tub bath -whirlpool bath b. cool washcloths to face, throat, abdomen, or over mouth (dry mouth) c. ask patient preference d. assure safety by checking the temperature of the compress and limiting the time that the compress remains in one area to avoid tissue damage

Cultural factors r/t pain in labor

determine how they will perceive, interpret, respond to, and manage the pain.

Cutaneous stimulation

involves stimulation of nerves via skin contact in an effort to reduce pain impulses to the brain 1. massage 2. thermal stimulation 3. Acupressure