Chapter 7 Nursing Management of Pain During Labor and Birth

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 may end up with a severe headache from the spinal anesthesia."

The nurse is admitting a client who is in labor who reports her husband and doula will be arriving shortly. Which action should the nurse prioritize in response?

Continue with the admission assessment

Which nursing intervention best aligns with the priority NANDA nursing diagnosis: Readiness for Enhanced Knowledge?

Encourage prenatal class attendance.

A client in labor receiving epidural anesthesia develops hypotension. Which of the following would the nurse do first?

Give an intravenous bolus of fluid

During labor, a pregnant patient's doula uses therapeutic touch and massage. Which outcome indicates that these approaches have been effective?

The patient is not requesting pain medication.

The pain of labor is influenced by many factors. What is one of these factors?

The woman is prepared for labor and birth.

Immediately following an epidural block, a pregnant patient's blood pressure suddenly falls to 90/50 mmHg. What action should the nurse take first?

Turn onto the left side or raise the legs.

All pain management modalities can slow labor if given too early except:

acupuncture

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?

headache following anesthesia

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 naloxone hydrochloride.

General anesthesia is a preferred method of pain management in childbirth.

False

A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states:

"Breathing patterns are distraction techniques taught to decrease pain in labor."

Which statement is true regarding analgesia versus anesthesia?

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area.

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?

acupressure

How does a woman who feels in control of the situation during labor influence her pain?

Feelings of control are inversely related to the client's report 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 reduce the sensation of pain for a limited period of time."

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as:

effleurage.

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)?

Administer supplemental oxygen.

The nurse has just administered morphine 2 mg IV to a laboring client. Which change in the fetal heart rate pattern would the nurse prioritize?

decreased variability

A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice?

"I respect your preference whether it is to have medication or not."

The nurse is caring for a client in the transition phase of the labor process. Which client statement requires nursing action?

"My lips and fingers are tingling."

A woman refuses to have an epidural block because she does not want to have a spinal headache after birth. What would be the nurse's best response?

"Spinal headache is not a usual complication of epidural blocks."

When collecting data to devise a labor plan for a multiparous woman, which question best allows the nurse to develop individualized strategies?

"Tell me how you handled labor pain in your past deliveries."

An experienced nurse is mentoring a graduate nurse and critiquing the graduate's shift handoff. Which statement requires clarification?

"The client reports a pain level of 8. She has a low pain tolerance."

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?

"The injection is given in the space outside the spinal cord."

A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching?

"The temperature of the water should be at least 105℉ (40.5℃)."

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching?

"You have no trouble walking around and using the bathroom after you receive the epidural."

A woman in labor states she wants to have epidural analgesia. When can this method of analgesia best be given?

1. Anytime during labor 2. During the transition phase of labor 3. During first stage of labor 4. During third stage of labor

Select the two most important nursing assessments immediately after a woman receives an epidural block

1. Bladder distention 2. Condition of IV site 3. Respiratory rate 4. Blood pressure 1. Bladder Distention and 4. BP

What drug should be immediately available for emergency use when a woman receives narcotics during labor?

1. Fetanyl (Sublimaze) 2. Diphenhydramine (Benadryl) 3. Lidocaine (Xylocaine) 4. Naloxone (Narcan) 4. Naloxone (Narcan)

Which of the following is most appropriately used for pain relief during labor when the cervix is dilated less than 4 cm?

1. Naloxone (Narcan) via IM route 2. Meperidine (Demerol) via IM route 3. Promethazine (Phenergan) via IM route 4. Fentanyl (Sublimaze) via epidural route

Which technique is likely to be most effective for back labor?

1. Stimulating the abdomen by effleurage 2. Applying firm pressure in sacral area 3. Blowing out in short breaths during each contraction 4. Rocking from side to side at the peak of each contraction 2. Applying firm pressure in sacral area

A nurse is serving as a doula to a client who is now in labor at an alternative birthing center. The client has opted for a water birth, and the nurse is now drawing the water into a large tub. What temperature should the nurse keep the water at?

37°C

A woman is in labor with her second child. She knows that she will want epidural anesthesia, and she has already signed her consent form. What must the nurse do before the woman receives the epidural?

Administer a fluid bolus through the IV line to reduce the risk of hypotension.

A client has opted to receive epidural anesthesia during labor. Which of the following interventions should the nurse implement to reduce the risk of a significant complication associated with this type of pain management?

Administration of 500 mL of IV Ringer's lactate

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.

A pregnant patient planning for labor is asking questions about pain control options. What should the nurse explain about pain control during labor?

Any medication should have maximum effect for the patient and minimal effect on the fetus.

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 fetal heart rate.

A client has just received combined spinal epidural. Which nursing assessment should be performed first?

Assess vital signs.

A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?

Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.

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?

Benzodiazepines enhance pain relief attained with opioids and cause sedation.

When entering the second phase of labor, a patient tells the nurse that the pain is severe and is unsure if pain medication should be used. Which nursing diagnosis should the nurse use to guide the care of the patient at this time?

Decision conflict related to the use of analgesia during labor

Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia?

Difficulty breathing

A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using?

Effleurage

Which nursing action is required before a client in labor receives an epidural?

Giving a fluid bolus of 500 ml

In providing culturally competent care to a laboring woman, which is a priority?

Identify how the client expresses labor pain.

The nurse is caring for a client who appears tense and apprehensive as labor progresses. Which nursing intervention is most helpful?

Initiate comfort measures

Which is identified as the primary outcome for initiating comfort measures during the labor process?

Maintain the labor process

The following are nursing measures commonly offered to women in labor. Which nursing intervention probably would be most effective in applying the gate-control theory for relief of labor pain?

Massage the woman's back.

A laboring client is restless and moving frequently in the bed. She appears to be more uncomfortable with the contractions but refuses pain medication when offered. The client's partner has left the room to stretch his legs. Which response by the nurse is most helpful?

Stand next to the client at the side of the bed.

Fentanyl has been administered to a client in labor. What assessment should the nurse prioritize?

Respiratory status

Which order by the health care provider would the nurse question if given in the active stage of labor?

Secobarbital for relaxation

When developing a labor plan with the client, which outcome is the priority?

The client will direct her pain management techniques.

Which possible outcome would be a major disadvantage of any pain relief method that also affects awareness of the mother?

The mother may have difficulty working effectively with contractions.

The nurse instructs the client about skin massage and the gate-control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?

This is a technique to prevent the painful stimuli from entering the brain.

The laboring client who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice?

This may prolong labor and increase complications.

There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain?

Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.

The nurse is caring for a woman in labor. Which of the following observations require immediate nursing intervention?

a. FHR of 90 beats/min between contractions b. maternal tachysystole c. contractions lasting 60 seconds with an interval of 90 seconds d. FHR baseline variability 1. b and c 2. a and d 3. a and b 4. c and d

A woman who is in the early first stage of labor asks how she can relieve her discomforts. The nurse knows that non-pharmacological techniques that can relieve discomforts include:

a. sacral pressure b. effleurage c. sitz bath d. laxatives 1. a and b 2. c and d 3. a and d 4. b and c

A laboring client has recently received intrathecal anesthesia for the treatment of pain. When monitoring the client for common adverse effects of this treatment, the nurse should prioritize:

blood pressure monitoring.

A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will:

instruct the client or her partner to perform light fingertip repetitive abdominal massage.

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?

less anxiety

A client in labor has administered an epidural anesthesia. Which assessment findings should the nurse prioritize?

maternal hypotension and fetal bradycardia

The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?

meperidine

A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication?

naloxone

Which medication is administered to reverse the depressant effects of opioids?

naloxone

A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client?

respiratory depression

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which effect?

respiratory depression

What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client?

starting an IV and hanging IV fluids

A woman's perception of pain can differ according to all of the following except:

the presentation, lie, and attitude of the fetus.

A nurse is caring for a client who has had a cesarean birth with general anesthesia. The nurse would assess the woman closely for which possible complication?

uterine atony

A woman who is pregnant with her first child phones an intrapartum facility and says her "water broke." The nurse should tell her to:

1. wait until she has contractions every 5 minutes for 1 hour 2. take her temperature every 4 hours and come to the facility if it is over 38 (100.4) 3. come to the facility promptly, but safely 4. call an ambulance to bring her to the facility

To determine the frequency of uterine contraction, the nurse should note the time from the:

1. beginning to end of the same contraction 2. end of one contraction to the beginning of the next contraction 3. beginning of one contraction to the beginning of the next contraction 4. contraction's peak until the contraction begins to relax 3. beginning of one contraction to the beginning of the next

A woman in active labor has contractions every 3 minutes lasting 60 seconds, and her uterus relaxes between contractions. The electronic fetal monitor shows the FHR reaching 90 beats/min for periods lasting 20 seconds during uterine contraction. The appropriate priority nursing action is to:

1. continue to monitor closely 2. administer oxygen by mask at 10 L/min 3. notify the health care provider 4. prepare for a c -section