Pain Management During labor and Birth
The nurse in an obstetric clinic is conducting client education with a group of expectant mothers. One young woman asks the nurse to tell the group what labor pain is like. What would be the nurse's best response? -"The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in." -"It has been described as the worst pain you will ever feel." -"It comes in waves." -"It is best evaluated by talking with visitors in the labor room because they know you best."
"The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in." Explanation: Pain sensations associated with labor originate from different places, depending on the stage of labor.
A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states: -"I can continue sitting up after the spinal is given." -"I may end up with a severe headache from the spinal anesthesia." -"The anesthesia will numb both of my legs to a level above my breasts." -"I will need to lie on my right side to reduce vena cava compression."
"I may end up with a severe headache from the spinal anesthesia." Explanation: Cerebrospinal fluid (CSF) leakage from the needle insertion site and irritation caused by a small amount of air that enters at the injection site and shifts the pressure of the CSF causes strain on the cerebral meninges, initiating headache pain.
The nurse is caring for a client in the transition phase of the labor process. Which client statement requires nursing action? - "My contractions are really intense now." -"My lips and fingers are tingling." -"My mouth and lips are so dry." -"I feel burning in my perineum."
"My lips and fingers are tingling." Explanation: When the client reports that her lips and fingers are tinging, the nurse is correct to understand that she is hyperventilating. To correct hyperventilation, the nurse instructs the client to slow the breathing. A paper bag or cupped hands is the correct nursing action. All of the other statements are normal for the client in the transition phase of labor. The nurse would moisten the client's lips or provide a lip balm for dry mouth or lips.
The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering? -Assess maternal blood pressure. -Assess for constipation. -Assess for dry mouth. -Assess fetal heart rate.
Assess fetal heart rate. Explanation: After administering an opioid to a laboring mother, the priority is to assess the impact on the fetus. Opioid administration can cross the placental barrier with symptoms including assessing heart rate and variability. After birth, there may be a decrease in alertness. Maternal factors of a decreased blood pressure, constipation and dry month are of a lower priority.
The nurse is caring for a laboring client who has been administered a regional block for pain management. What is the nurse's priority action? - Ensure that emergency equipment is readily available -Assess the client's pain at least once every 20 minutes -Encourage the client to adopt a side-lying position whenever possible -Monitor the client closely for nausea and vomiting
Ensure that emergency equipment is readily available Explanation: Emergency equipment must be kept at hand when a client receives regional anesthesia. A side-lying position is unnecessary and nausea is not a common adverse effect. Pain assessment should be more frequent than every 20 minutes.
The nurse is caring for a client who appears tense and apprehensive as labor progresses. Which nursing intervention is most helpful? -Instruct on the labor process -Initiate comfort measures -Limit interruptions in the room -Encourage support person interaction
Initiate comfort measures Explanation: Initiating comfort measures allows the tense client to relax which may decrease anxiety and apprehension. Comfort measures can include a variety of interventions such as ice chips, lip balm or touch, massage, and acupressure. This interaction between the nurse and client also conveys a caring, supportive attitude. This establishes a trusting relationship which again decreases anxiety. All other options are appropriate but not as helpful personally to the client in labor.
A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines that this drug is effective when the woman demonstrates which finding? -increased cervical dilation -increased feelings of control -less anxiety -decreased sedation
Less anxiety Explanation: Promethazine is used in combination with an opioid to decrease nausea and vomiting and lessen anxiety. It may also be used to increase sedation. It does not affect the progress of labor. Benzodiazepines are used to calm a woman who is out of control, allowing her to relax enough to participate effectively during labor.
Which is identified as the primary outcome for initiating comfort measures during the labor process? -Improve the psyche of the mother -Increase client satisfaction -Maintain the labor process -Acknowledge pain during childbirth
Maintain the labor process Explanation: All of the outcomes are accurate but the primary outcome is to maintain the labor process. By relaxing the mother, it is easier for her to work with her body and facilitate the labor process
A woman's perception of pain can differ according to all of the following except: -her expectations and preparation for labor. -the length of her labor. psychosocial, physiologic, and cultural influences. -fear, anxiety, and self-efficacy. -the presentation, lie, and attitude of the fetus.
the presentation, lie, and attitude of the fetus. Explanation: Fetal position can influence a client's perception of pain. Fetal attitude does not influence a client's perception of pain.
The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best? -"The analgesia will limit your ability to be out of bed without assistance." " -The analgesia will block pain sensation and limit your ability to push." - "The analgesia will reduce the sensation of pain for a limited period of time." -"The analgesia will allow for a pain-free birth experience."
"The analgesia will reduce the sensation of pain for a limited period of time." Explanation: It is best to prepare the client for the role of analgesia in her labor experience. It is best to explain that analgesia will reduce, not block or eliminate, the pain sensation for a limited period of time depending upon the medication selected. Stating the inability to get out of bed does not answer the client's question about pain relief.
A pregnant patient received a narcotic analgesic 2 hours before delivery. The newborn is lethargic and difficult to arouse. What should the nurse prepare to do to help this newborn? -Administer intravenous fluids. -Apply oxygen and place in a heated bassinet. -Administer naloxone hydrochloride. -Provide tactile stimulation to encourage crying.
Administer naloxone hydrochloride. Explanation: Naloxone hydrochloride is a narcotic antagonist that counteracts the effect of narcotic analgesics. It is used to counteract respiratory depression in newborns when a woman has received a narcotic analgesic during labor. Intravenous fluids, oxygen, a heated bassinet, or tactile stimulation will not counteract the effects of a narcotic analgesic given before delivery.
A client in labor has received a spinal epidural block. Which nursing intervention should the nurse prioritize after assessing maternal hypotension and changes in the fetal heart rate (FHR)? -Change the client to the supine position. -Administer supplemental oxygen. -Lower the woman's legs -Stop IV fluid administration.
Administer supplemental oxygen. Explanation: Complications of a spinal epidural block include maternal hypotension, which affects the FHR. Supplemental oxygen should be administered to keep oxygenation levels appropriate for the mother and the fetus. The client should be placed in a semi-Fowler's position. Stopping the IV fluid may cause dehydration, and other positions may not have a positive effect on the blood pressure. Raising not lowering the woman's legs would be appropriate.
A client receives an epidural anesthetic. Which medication would the nurse anticipate the primary care provider will prescribe if the client develops moderate hypotension? -betamethasone -methylergonovine -atropine -ephedrine
ephedrine Explanation: A hypotensive agent such as ephedrine is given to elevate blood pressure if hypotension occurs.
A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered? -butorphanol -fentanyl -naloxone - promethazine
naloxone Explanation: Naloxone is an opioid antagonist used to reverse the effects of opioids such as respiratory depression. Butorphanol and fentanyl are opioids and would cause further respiratory depression. Promethazine is an ataractic used as an adjunct to potentiate the effectiveness of the opioid.
The nursing instructor is conducting a class discussion on the various agents used during labor and delivery to assist the client. The instructor determines the class is successful after the students correctly choose which factor as true about the use of systemic analgesia? -Opioids are more effective if given PO. -Benzodiazepines enhance pain relief attained with opioids and cause sedation. -Barbiturates are used primarily in active labor and during transition. -Ataractics are used for pain relief but may cause nausea and vomiting.
Benzodiazepines enhance pain relief attained with opioids and cause sedation. Explanation: Barbiturates are used in latent labor for their minor tranquilizng and sedative effects. They can also be used just before general anesthesia, if required. Ataractics are opioid agonists used to decrease anxiety, nausea, and vomiting. Opioids may be given IV, intrathecally, or epidurally.
A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? -Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. -Agree with the client, and administer the drug immediately to keep the pain manageable. -Explain to the client that narcotics should only be administered an hour or less before birth. -Refuse to administer narcotics because they can develop dependency in the client and the fetus.
Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. Explanation: The timing of administration of narcotics in labor is especially important as, if given too early (before 3 cm cervical dilatation), they tend to slow labor. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, narcotics are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.
A 21-year-old G1P0 was admitted four hours ago in labor and she is now requesting an epidural. Which nursing action should the nurse prioritize for this client? -Explain the procedure, answer any questions, and obtain consent for the epidural. -Insert an IV line and administer a 500 mL bolus of Ringer's lactate. -Prepare the sterile field and clean the patient's back with a povidone-iodine solution. -Administer vasopressors as ordered.
Insert an IV line and administer a 500 mL bolus of Ringer's lactate. Explanation: To reduce the risk of hypotension, it is important for the woman to be well hydrated. This is accomplished by administering a bolus of 500- to 2,000-mL IV fluid. Inserting an IV line and administering an IV bolus such as with Ringer's lactate solution are the only appropriate nursing interventions. The nurse can answer questions and explain the procedure; however, the anesthesiologist will obtain consent, prepare the sterile field, and clean the patient's back. Vasopressors are not routinely ordered for an epidural procedure and are used only if the patient develops hypotension.
