Maternity Maximizing Comfort for the Laboring Mother EAQ

The health care provider recommends the patient use nitrous oxide during labor to help with analgesia. The patient asks the nurse about the drug. Which does the nurse explain to the patient about nitrous oxide?

"It is given as a gas that you can self-administer." Nitrous oxide, commonly known as "laughing gas," is available in a 50:50 mix with oxygen using a mask, and the patient can self-administer it. It is not administered intravenously but rather through inhalation. It is not given continuously in oral doses every 12 hours. Nitrous oxide does not completely relieve pain but reduces the woman's perception or pain and decreases anxiety.

The nurse is caring for a patient in labor who is having an indwelling catheter threaded into the epidural space for the administration of pain medication. Which does the nurse tell the patient?

"You may experience a momentary twinge down your hip or back." When a laboring woman receives an indwelling catheter threaded into the epidural space, the nurse should tell the patient she may have a momentary twinge down her leg, hip, or back. This feeling is normal and is not a sign of injury. The patient's body will not go numb after 15 seconds. The patient does not have to notify anyone immediately if there is a tingling sensation. All drugs used for pain management have some kind of side effect, regardless of the route of administration.

The nurse is instructing a childbirth class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths/min. Which should the patient's rate be while performing slow-paced breathing techniques?

11 breaths/min The ideal rate for slow-paced breathing is half the normal breathing rate. Because her baseline respiratory rate is 22 breaths/min, the ideal breathing rate for slow-paced breathing is 11 breaths/min. The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate. Nine breaths per minute is too low for a baseline rate of 22 breaths/min. The ideal rate for slow-paced breathing is half the normal breathing rate; therefore 15 breaths/min would still be too fast and may not be effective. The ideal rate for slow-paced breathing is half the normal breathing rate; therefore 20 breaths/min would still be too fast and may not be effective.

Which information would the nurse consider when educating patients and support people about nonpharmacologic pain management techniques?

Acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain. Accupressure is an effective nonpharmacologic technique that can be used to relieve a variety of pain during labor. Music is a relaxation technique that is encouraged for women to use during labor. Hydrotherapy is not offered in all facilities; however, if available, the nurse would refer to the policy of the facility. A 15-minute time line is not a standard policy for hydrotherapy during labor. Effleurage and counter-pressure are two different massage techniques that are used for an unmedicated birth. Counter-pressure is effective for lower back pain and hip pain during labor.

After delivering a healthy baby with epidural anesthesia, a woman on the postpartum unit reorts having a severe headache. Which action does the nurse anticipate in the woman's plan of care? Select all that apply. One, some, o r all responses may be correct.

Administering oral analgesics Assisting with a blood patch procedure Frequently monitoring vital signs Conservative management for a postdural puncture headache (PDPH) includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch (EBP) is the most rapid, reliable, and beneficial relief measure for PDPH . Close monitoring of vital signs is essential. The nurse should suspect the patient is suffering from a PDPH. Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012).

The nurse is caring for a patient in the last trimester of pregnancy. Which will the patient display related to the effects of fear and anxiety during labor?

An increase in muscle tension Fear and excessive anxiety lead to increased muscle tension. It causes more catecholamine secretion. This increases the stimuli to the brain from the pelvis due to increased muscle tension and decreased blood fiow. Thus fear and anxiety magnify the perception of pain. Anxiety does not increase uterine contractions but reduces the effectiveness of the contractions leading to increased discomfort. This slows the progress of labor.

Which action must the nurse take when implementing aromatherapy for a patient in labor?

Ask the patient to choose the scents. Certain scents can evoke pleasant memories and feelings of love and security. So, it is helpful if the patient is allowed to choose the scents. The oils must never be applied in full strength directly on to the skin. Most oils should be diluted in a vegetable oil base before use. Inhaling vapors from the oil can lead to unpleasant side effects like nausea or headache. Drops of essential oils can be put on a pillow or on a woman's brow or palms or used as an ingredient in creating massage oil. It is not applied to the hair.

Which intervention will the nurse perform while caring for a patient who is set to receive spinal anesthesia?

Assess maternal vital signs. The nurse must assess maternal vital signs, level of hydration, labor progress, and fetal heart rate (FH R) and pattern before the procedure is initiated. This helps to prepare for a possible emergency. When the procedure is initiated, the nurse ensures that oxygen and suction are readily available to ensure airway at all times. While the anesthesia is in effect, the nurse must monitor the patient for signs of toxicity and keep the side rails up on the bed to ensure patient safety.

Which effect does a pudendal nerve block have on a laboring patient?

Decrease in pain in the vagina and perineum A pudenda I nerve block anesthetizes the pudenda I nerves peripherally. It relieves pain in the lower vagina, vulva, and perineum. It does not relieve the pain from uterine contractions. The bearing-down reflex is lessened or lost completely. It tends to cause fewer fetal complications and does not affect the FHR.

The nurse teaches acupressure methods for pain relief during labor to a couple in the prenatal clinic. Which will the nurse teach about acupressure? Select all that apply. One, some, or all responses may be correct.

Blood circulation is enhanced. Flow of qi ( energy) is restored. Pressure is applied with the fingers. Pressure is applied with contractions. Pressure is usually applied with the heel of the hand, fist, or pads of the thumbs and fingers. Pressure is applied with contractions initially and then continuously as labor progresses to the transition phase at the end of the first stage of labor. Acupressure is said to promote the circulation of the blood, the harmony of yin and yang, and the secretion of neurotransmitters. Thus, acupressure maintains normal body functions and enhances well-being. Acupressure is applied over the skin without using lubricants. In acupuncture, the flow of qi (energy) is restored.

Which will the nurse teach the patient about the benefits of breathing techniques in the second stage of labor?

Causes increase in abdominal pressure In the second stage of labor, breathing techniques are used to increase abdominal pressure and expel the fetus. In the first stage of labor, breathing helps to promote the relaxation of the abdominal muscles, thereby increasing the size of the abdominal cavity. This lessens the discomfort during contraction caused by the friction between the abdominal wall and the uterus. It also relaxes the muscles of the genital area and does not interfere with fetal descent.

The nurse acts as an advocate for the patient during an informed consent for anesthesia. Which care must the nurse take while obtaining an informed consent? Select all that apply. One, some, or all responses may be correct.

Check for the patient's signature. Check for the date on the consent form. Check the anesthetic care provider's signature. The nurse must ensure that the consent form has the correct date. The nurse must ensure that the patient has not been compelled to consent for the procedure. The form must carry the signature of the anesthetic care provider, certifying that the patient has received and expresses understanding of the explanation. The consent form must be written or explained in the patient's primary language. The nurse need not obtain a family member's signature on the document. The patient's signature is important.

Which intervention will the nurse perfor m to provide emotional support to a patient in labor? Select all that apply. One, some, or all responses may be correct.

Compliment patient efforts during labor. Use a calm, confident approach. Involve the patient in care decisions. The nurse must offer emotional support by complimenting the patient and offering positive reinforcement for efforts during labor. The patient must be involved in decision making regarding own care. The nurse must use a calm and confident approach when assisting the patient during labor. The nurse may offer food and nourishment, if allowed by the primary health care provider. The nurse must encourage participation in distracting activities and nonpharmacologic measures for comfort.

Which intervention does the nurse perform to provide a relaxed environment for labor?

Control sensory stimuli. The nurse must assist the patient by providing a quiet and relaxed environment. A relaxed environment for labor is created by controlling sensory stimuli, such as light, noise, and temperature, as per the patient's preferences. The nurse must provide reassurance and comfort by sitting rather than standing at the bedside whenever possible. The nurse must not encourage or hurry the patient for rapid birth. The nurse must maintain a calm and unhurried attitude when caring for the patient.

A woman is experiencing back labor and reports having intense pain in her lower back. The nurse instructs the support person to use which nonpharmacologic technique?

Counterpressure against the sacrum Counterpressure can be provided to the lower back and either hip and is effective when the pain is concentrated in those areas. Typically, the partner might take on the role of using massage during childbirth; however, if the partner is becoming fatigued and the patient is finding this method effective, the nurse may want to offer to step in to assume the role. Slow-paced breathing is a good technique for contraction pain; however, it is not the recommended technique to help with lower back pain. Effleurage is effective in providing reassurance, comfort, or presence, but it is not a recommended technique to help with lower back pain. Guided imagery or relaxation techniques are effective for calming a laboring woman during contractions; however, these techniques are not recommended to help with lower back pain.

Which major side effect will the nurse expect if a patient in labor is administered diazepam?

Disrupted temperature control i n the newborn. Diazepam disrupts thermoregulation in the newborn. Thus the newborn is less able to maintain body temperature. Benzodiazepines , when given with an opioid analgesic, seem to enhance pain relief and reduce nausea and vomiting. Pain is magnified if a barbiturate is given without analgesic to a patient who is experiencing pain. This is because the normal coping mechanism in the patient may be blunted. Barbiturates should be avoided if birth is anticipated within 12 to 24 hours because they have the potential to cause neonatal central nervous system depression.

The nurse is teaching pain relief techniques to a group of expectant patients. Which will the nurse teach the patients about the gate-control theory of pain?

Distractions block the nerve pathways. The gate-control theory of pain explains the way pain relief techniques work to relieve the pain of labor. Distractions close a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. According to this theory only a limited number of sensations can travel through the sensory nerve pathways to the brain at one time. When the laboring patient engages in motor activity and neuromuscular activity, activity within the spinal cord itself further modifies the transmission of pain.

During the second phase of labor, the patient initiates pattern-paced breathing. Which adverse symptom must the nurse watch for when the patient initiates this method?

Dizziness The nurse must watch for symptoms of hyperventilation and resulting respiratory alkalosis. Symptoms of respiratory alkalosis during pattern-paced breathing include dizziness, light-headedness, tingling of fingers, or circumoral numbness. Pallor, nausea, and diaphoresis are generally observed in the active and transition phases of the first stage of labor. They are physiologic effects of pain.

Which is important for nurses to understand about the use of systemic analgesics during labor?

Effects on the newborn can include significant neonatal respiratory depression. Effects depend on the specific drug given, the dosage, and the timing. Effects on the newborn can include significant respiratory depression. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

Which intervention will the nurse perform for the patient demonstrating increased anxiety at the onset of labor?

Encourage a support person to stay with the patient. The patient in labor prefers to have a familiar person to support during the labor process. The nurse must encourage the support person to stay with the patient. The nurse need not assess blood pressure every 10 minutes unless the patient is in severe distress. The patient can use hypnosis to relieve pain only if the patient has learnt and practiced the technique. The nurse must not encourage the patient to use an epidural unless the primary health care provider or the patient feels the need for the same.

A patient in latent labor who is positive for opiates on a urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. Which is the nurse's most appropriate analgesic for pain control?

Fentanyl Fentanyl is a commonly used opioid agonist analgesic for patients in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Promethazine is not an analgesic; it is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Butorphanol tartrate is an opioid agonistantagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nalbuphine is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

When monitoring a woman in labor who has just received spinal analgesia, which assessment finding should the nurse report to the health care provider? Select all that apply. One, some, or all responses may be correct.

Fetal heart rate of 100 beats/min Minimal variability on a fetal heart monitor. After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. I f signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

Which will the nurse teach the patient about the reason for effectiveness of the intradermal water block? Select all that apply. One, some, or all responses may be correct.

Gate-control mechanism Counterirritation mechanism Increase in endogenous opioids The intradermal water block is known to be effective in pain management during labor. It uses the gatecontrol theory. Pain sensations travel along the sensory nerve pathways to the brain, but only a limited number of sensations, or messages, can travel through these nerve pathways at one time. It is also based on the mechanism of counterirritation. Localized pain is reduced in one area by irritating the skin in an area nearby. It also increases in the level of endogenous opioids produced by the injections. Increased prostaglandin levels are found in patients with a history of dysmenorrhea, which increases pain during childbirth. When endogenous opioids increase, there is an increase in beta endorphins.

Which kind of anesthesia may be necessary for a patient who is to have an emergency cesarean birth due to fetal distress?

General anesthesia General anesthesia may be necessary if indications necessitate rapid birth (vaginal or emergent cesarean) when there is a pressing need for time and/or primary health care providers to perform a block. Pudendal nerve block is administered late in the second stage of labor. It may be required if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Nitrous oxide mixed with oxygen can be inhaled in 50% or less concentration to provide analgesia during the first and second stages of labor. Local infiltration anesthesia may be used when an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia.

The nurse is caring for a nulliparous patient in labor. Which is the reason why the experiences for a nulliparous patient may be different from that of a multiparous patient?

Greater fatigue due to longer duration of labor Parity influences the perception of labor pain. The nulliparous patient often has longer labor and therefore greater fatigue. Sensory pain for nulliparous women is often greater than that for multiparous women during early labor, because their reproductive tract structures are less supple. Affective pain in the nulliparous patient is greater in the first stage as compared to a multiparous patient. It decreases for both patients during the second stage of labor. During the second stage of labor, the multiparous patient may experience greater sensory pain than the nulliparous patient. This is because tissues of the multiparous patient are more supple and increase the speed of fetal descent, thereby intensifying the pain.

Which is accurate about tactile approaches to comfort management?

Hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. The woman and her partner should experiment with massage before labor to see what might work best. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

Which intervention will the nurse provide to prevent respiratory al kalosis in the patient with hyperventilation?

Have the rebreath into a paper bag. Hyperventi lation often occurs duringthe second phase of labor when pattern-paced breathing is adopted by the patient. The nurse must have the patient breathe into a paper bag held tightly around the mouth and nose. This enables the patient to rebreathe carbon dioxide and replace the bicarbonate ions. The patient also can breathe into cupped hands if no bag is available. Gentle massages during labor enhance comfort and reduce tension. The patient may be provided with nourishment if allowed by the primary health care provider. This provides support to the patient during labor. Maintaining a breathing rate that is no more than twice the normal rate will lessen chances of hyperventilation.

Several hours into an unmedicated labor, a woman reports lightheadedness and anxiety. The nurse assists the woman with patterned breathing techniques to address which condition?

Hyperventilation Hyperventilation is sometimes a problem if a woman is breathing too rapidly, especially in an unmedicated birth that has been prolonged. Dizziness, lightheadedness, anxiety, numbness of the extremities, and tingling of the extremities are signs of hyperventilation. Patients with hypertension will typically report having a headache, chest pain, and shortness of breath. Patients experiencing a heart attack will typically report having chest pain, referred arm pain, and shortness of breath. Patients with preeclampsia will typically report having heartburn, headache, visual changes, and dizziness.

The nurse is teaching a couple about the use of imagery and visualization in managing pain during labor. Which is the patient expected to do during this technique? Select all that apply. One, some, or all responses may be correct.

Imagine breathing in light and energy. Imagine walking through a restful garden. Envisage breathing out worries and tension. Imagery and visualization are useful techniques in preparation for birth and are often used in combination with relaxation. Imagery involves techniques, such as breathing in light and energy, imagining a walk through a restful garden, or envisaging breathing out worries and tension. Relaxation or reduction of body tension is a technique that involves rhythmic motion that stimulates the mechanoreceptors of the brain, but dance and rhythmic movements are not considered a form of imagery and visualization. The nurse must recognize the signs of tension, such as clenching of fists when the laboring patient is in pain.

Which physiologic effect results from labor pain?

Increased production of catecholamines. The production of "fight-or-flight" hormones increases as a result of labor pain and anxiety. These include the catecholamines epinephrine and norepinephrine. Metabolic rate increases, not decreases, during labor. Pain and anxiety increase metabolic rate further through increased production of catecholamines. Uterine and placental blood flow is decreased by high catecholamine levels. The maternal demand for oxygen increases, not decreases, as a physiologic effect of labor.

Which condition is a contraindication to subarachnoid and epidural blocks?

Infection at injection site If the patient has an infection at the needle insertion site, subarachnoid or epidural blocks are contraindicated. Infection can spread through the peridural or subarachnoid spaces if the needle traverses an infected area. Maternal hypovolemia, not hypervolemia, leads to increased sympathetic tone to maintain the blood pressure. An anesthetic technique that blocks the sympathetic fibers can produce significant hypotension that can endanger the mother and fetus. Maternal hypotension, not hypertension, is contraindicated for anesthetic blocks. Increased intracranial pressure caused by a mass lesion is a contraindication for anesthetic blocks.

Which intervention must the nurse perform when assisting a patient in labor who has been administered nitrous oxide for analgesia?

Instruct the patient to breathe normally between contractions. The nurse must instruct the patient to remove the mask and breathe normally between contractions. The use of nitrous oxide does not depress uterine contractions or cause adverse reactions in the fetus and newborn. The nurse need not monitor FHR or maternal blood pressure every 2 minutes. The patient must place the mask over the mouth and nose or insert the mouthpiece 30 seconds before the onset of a contraction (if regular), or as soon as a contraction begins (if irregular).

During a prenatal assessment, a patient asks about the use of hypnosis for pain management. Which will the nurse teach the patient about this modality? Select all that apply. One, some, or all responses may be correct.

It gives a better sense of control. It is a form of deep relaxation or meditation. It can cause dizziness, nausea, and headache. Hypnosis is a form of deep relaxation, like daydreaming or meditation. It enhances relaxation and diminishes fear, anxiety, and perception of pain. It allows the patient to have a greater sense of control over painful contractions. Failure to de-hypnotize properly may result in mild dizziness, nausea, and headache. Self-hypnosis must be learnt during childbirth preparation classes. It is not performed by a support person. Although hypnosis is beneficial, studies have not found it to be more effective than the use of a placebo or other interventions for pain management during labor.

During a prenatal assessment a patient asks the nurse about the disadvantages of spinal anesthesia. Which will the nurse teach the patient about the potential effect of spinal anesthesia?

It increases probability of operative birth. When a spinal anesthetic is given, the need for episiotomy, forceps-assisted birth, or vacuum-assisted birth tends to increase because voluntary expulsive efforts are reduced or eliminated. Maternal consciousness is maintained. Fetal hypoxia is absent as maternal blood pressure is maintained within a normal range. There is no muscular tension; excellent muscular relaxation is achieved.

During a prenatal assessment, the nurse teaches the patient about nonpharmacologic pain management. Which will the nurse tell the patient about this method?

It provides the patient with a sense of control. The patient makes choices about the nonpharmacologic pain management methods that are best suited. This provides the patient with a sense of control over childbirth. These measures are relatively simple and inexpensive. They do not require intensive training. However, the patient may obtain best results from the practice. It can be used throughout labor.

A patient asks the nurse about the use of transcutaneous electrical nerve stimulation (TENS). Which will the nurse teach about (TENS)?

It releases continuous low-intensity impulses. When TENS is applied for pain relief, the electrodes provide continuous low-intensity electrical im pulses or stimuli from a battery-operated device. TENS is most useful for lower back pain during the early first stage of labor. TENS involves the placing of two pairs of flat electrodes on either side of the woman's thoracic and sacral spine. During a contraction, the patient increases the stimulation from low to high intensity by turning the control knobs on the device.

When caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur?

Lower portion of the abdomen Visceral pain in the first stage of labor occurs in the lower portion of the abdomen. Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates. Pressure and traction on uterine tubes, ovaries, ligaments, nerves, and uterine ischemia also cause visceral pain. Pain that originates in the uterus radiates to the gluteal area, iliac crests, abdominal wall, thighs, lumbosacral area of the back, and lower back. This pain is called referred pain.

When caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur?

Lower portion of the abdomen Visceral pain in the first stage of labor occurs in the lower portion of the abdomen. Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates. Pressure and traction on uterine tubes, ovaries, ligaments, nerves, and uterine ischemia also cause visceral pain. Pain that originates in the uterus radiates to the gluteal area, iliac crests, abdominal wall, thighs, lumbosacral area of the back, and lower back. This pain is called referred pain.

The nurse is caring for a patient in the first stage of labor. Which nerve segment transmits pain impulses during this stage? Select all that apply. One, some, or all responses may be correct.

Lumbar spinal nerve segment L1 T10 to T12 spinal nerve segments Upper lumbar sympathetic nerves Pain impulses during the first stage of labor are transmitted via the TlO to Tl2 and L1 spinal nerve segments, and upper lumbar sympathetic nerves. These nerves originate in the uterine body and cervix. Pain impulses during the second stage of labor are transmitted through the pudenda! nerve through S2 to S4 spinal nerve segments and the parasympathetic system.

Which intervention will the nurse perform for a la boring patient with hypotension and fetal bradycardia? Select all that apply. One, some, or all responses may be correct.

Notify the primary health care provider or anesthesiologist. Monitor the fetal heart rate (FHR) every 5 minutes. Administer oxygen using a nonrebreather face mask. The nurse must immediately notify the primary health care provider, anesthesiologist, or nurse anesthetist. The nurse must administer oxygen by nonrebreather face mask at 10 to 12 L/min or as per health care facility's protocol. The FHR must be monitored every 5 minutes. The patient must be turned to lateral position, or a pillow or wedge must be placed under a hip to displace the uterus. The lateral recumbent position may be used when spinal anesthesia is administered. Maternal blood pressure must be monitored every 5 minutes.

The nurse is assisting a patient in labor. Which breathing pattern must the nurse remind the patient to use when the contractions increase in frequency and intensity in the first phase of labor?

Modified-paced breathing During the first phase of labor, as contractions increase in frequency and intensity, the patient must change breathing. Patterns to a modified-paced breathing technique. This breathing pattern is shallower and faster than the patient's normal rate of breathing, but it should not exceed twice the resting respiratory rate. Slowpaced breathing is performed at approximately half the normal breathing rate and is initiated when the patient can no longer walk or talk through contractions. Patterned-paced breathing is suggested in the second phase of labor. It consists of panting breaths combined with soft blowing breaths at regular intervals. The patterns may vary, the 3:1 pattern is pant, pant, pant, blow and the 4:1 pattern is pant, pant, pant, pant, and blow.

The nurse is assisting a patient who has just received spinal anesthesia (block). Which intervention does the nurse perform to prevent supine hypotension?

Place a wedge under one of the hips. The nurse places a wedge under one of the hip of the patient or tilts the operating table to displace the uterus laterally to prevent supine hypotensive syndrome. The patient is assisted to lateral recumbent position with back curved to widen the intervertebral space to inject anesthetic solution into the spinal canal. After the anesthetic solution has been injected, the patient may be positioned upright to allow the hyperbaric anesthetic solution to flow downward to obtain the lower level of anesthesia suitable for a vaginal birth. To obtain the higher level of anesthesia desired for cesarean birth, the patient is to be positioned supine with head and shoulders slightly elevated.

Which is a cause of somatic pain in a patient who is in the second phase of labor? Select all that apply. One, some, or all responses may be correct.

Pressure against the bladder Distention of the peritoneum Stretching of the perineal tissue Somatic pain is a result of distention and traction of the peritoneum, stretching of the perineaI tissue, and pressure against the bladder and rectum. This pain is intense, sharp, burning, and well localized in the second stage of labor. Uterine ischemia, or decreased blood flow to the uterus, causes pain in the first stage of labor. Involuntary uterine contractions leading to cervical dilation and effacement also lead to pain in the first stage.

Which intervention will the nurse perform while caring for a la boring patient who has been administered regional anesthesia?

Provide an indwelling urinary catheter. A distended bladder can inhibit uterine contractions and fetal descent. This slows down the progress of labor. Therefore the nurse must provide an indwelling urinary catheter immediately after anesthesia has been initiated, and it must be left in place for the remainder of the first stage of labor. Spinal nerve blocks can reduce bladder sensation. Therefore the patient should empty the bladder before the induction of the block. The patient should be encouraged to void at least every 2 hours thereafter. The patient's position should be alternated from side to side every hour, to ensure adequate distribution of the anesthetic solution and to maintain blood circulation to the uterus and placenta.

The nurse is caring for a patient who is using fentanyl citrate through patient-controlled analgesia (PCA) while in labor. Which effect of fentanyl citrate does the nurse expect?

Provides quick relief to pain Fentanyl citrate is a potent short-acting opioid agonist analgesic. Therefore it provides quick pain relief. It rapidly crosses the placenta, so it is present in the fetal blood within 1 minute after intravenous maternal administration. It is a short-acting drug, so the patient will require more frequent dosing. It is often administered as a patient-controlled analgesic. It has fewer neonatal effects as compared to meperidine and causes less maternal sedation and nausea.

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman reports pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this is which type of pain?

Referred As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perinea! tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

The nurse is caring for a patient who has been administered nalbuphine while in labor. The nurse will watch for which sign of opioid withdrawal? Select all that apply. One, some, or all responses may be correct.

Rhinorrhea Piloerection Muscle spasms Nalbuphine is not suitable for patients with opioid independence. Antagonist activity can precipitate opioid withdrawal symptoms in these patients. Withdrawal symptoms include rhinorrhea, piloerection or gooseflesh, and muscle spasms. Sedation and confusion are often observed in the patient who received butorphanol.

Which is accurate about how differing experiences affect labor pain?

Sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

Where does an anesthesia provider inject an epidural anesthesia (block)?

T8 to S1 If a cesarean birth is to be conducted an epidural anesthesia (block) is administered from at least T8 to S1. A block from T10 to S5 is required for relieving the discomfort of labor and vaginal birth. In spinal anesthesia (block), an anesthetic solution containing a local anesthetic alone or in combination with an opioid agonist analgesic is injected between L3 to LS. Ll to L3 is not blocked for anesthesia.

Which will the nurse teach a couple expecting their first child about the use of therapeutic touch (TT) to relieve pain during labor?

TT aka therapeutic touch uses the concept of energy fields within the body. Therapeutic touch (TT) uses the concept of energy fields within the body, called prana. Specially trained persons lay hands on the patient to redirect energy fields associated with pain. According to this concept, prana is thought to be deficient in some people who are in pain. Counterpressure is steady pressure applied by a support person to both hips to cope with the sensation of internal pressure. Hand and foot massage is found to be especially relaxing in advanced labor when hyperesthesia limits the patient's tolerance for touch on other parts of the body.

The nurse is assisting a patient who is prepared to use the paced breathing method. Which will the nurse remind the patient to do at the beginning of the breathing pattern?

Take a deep relaxing breath. The patient must remember that all breathing patterns begin with a deep, relaxing "cleansing breath" to "greet the contraction." The patient must then exhale a deep breath to "blow the contraction away." These deep breaths ensure adequate oxygen for the mother and the baby and signal that a contraction is beginning or has ended. The patient must take three to four breaths per minute when performing slow-paced breathing. As contractions increase in frequency and intensity, the patient takes shallow, fast breaths, about 32 to 40 per minute.

Which statement regarding pain experienced during labor is accurate?

The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, and gluteal area. Second-stage labor pain is intense, sharp, burning, and localized. Third-stage labor pain is similar to that of the first stage.

The nurse is teaching a couple about nonpharmacologic pain relief measures during labor. Which will the nurse tell the couple about the use of counterpressure?

The support person applies pressure to the sacral area. Counterpressure is steady pressure applied by a support person to the sacral area with a firm object, such as a tennis ball or the fist or heel of the hand. Effleurage brings relief in the first stage of labor. Effleurage is light stroking or massaging of the abdomen, thigh, or chest, in rhythm with breathing during contractions. It is generally performed on the abdomen, but the presence of monitor belts makes it difficult to perform effleurage on the abdomen.

Which will the nurse teach the patient about the benefits of combining relaxation with walking, slow dancing, or rocking?

This method may help the baby rotate through the pelvis. When relaxation is combined with an activity such as walking, slow dancing, rocking, and position changes, it helps the baby to rotate through the pelvis. Simple relaxation exercises can help couples with the stresses of pregnancy, childbirth, and adjustment to parenting and can be a form of stress management throughout life. Breathing techniques provide distraction and diversion from pain. It helps to increase abdominal pressure in the second stage of labor and assists in expelling the fetus.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern and complains of feeling dizzy and lightheaded. Which should be the nurse's immediate response?

To help the woman breathe into a paper bag. The woman is exhibiting signs of hyperventilation . This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Telling her to breathe more slowly does not ensure a change in respirations. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression because this woman, being in the transition phase, is near the birth process. The side-lyng position is appropriate for supine hypotension.

The nurse caring for a patient in labor asks the support person to use heat application for pain relief. Why is heat applied to the body?

To relieve general backache The application of heat enhances relaxation and reduces pain during labor. Heat application is effective for general backache from fatigue or back pain caused by a posterior presentation. Cold applications, such as cold cloths, frozen gel packs, or ice packs, may be applied to relieve muscle spasms. Cold, not heat, is applied to the chest to increase comfort when the patient feels warm. Neither heat nor cold should be applied over ischemic or anesthetized areas because tissues can be damaged.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

Turn the woman to the left lateral position or place a pillow under her hip. Turning the woman to her left side is the best action to take in this situation because this will increase placental perfusion to the infant while waiting for the health care provider's instruction. Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Hypotension indicated by a 20% drop from preblock level is an emergency and action must be taken.

Which condition contraindicates hydrotherapy? Select all that apply. One, some, or all responses may be correct.

Viral infection Preterm labor Excessive vaginal bleeding Patients with infectious diseases, such as a viral infection, as well as fever, are contraindicated for hydrotherapy use. Tub hydrotherapy is also contraindicated for patients who are in preterm labor. Patients with vaginal bleeding greater than a normal blood show are contraindicated for hydrotherapy use. Vitamin deficiency and high blood pressure are not contraindicating factors for hydrotherapy.

In which situation is local perinea! infiltration anesthesia used?

When an episiotomy is required Local perinea! infiltration anesthesia may be used when an episiotomy is to be performed. It may also be used when lacerations must be sutured after birth in a patient who does not have regional anesthesia. Pudenda! nerve block is administered late in the second stage of labor if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Low spinal anesthesia (block) may be used for cesarean birth.