Chapter 9: Pain Management during L
sd sd sd sd sd
abor and Birth
sd sd
Thesdlaborsdnursesdreportssdtosdthesdnursesdonsdthesdoncomingsdshift,sd"Thesdwo
mansdinsdlaborsdroomsd2sdissdhandlingsdhersdpainsdverysdwell.sdShesdsmilessdwhe
neversdIsdgosdinsdtosdtalksdtosdher,sdandsdshesddoesn'tsdcomplainsdatsdall!"sdWhatsda
ssessmentsdbysdthesdoncomingsdlaborsdnursesdwouldsdbestsdrevealsdifsdthesdoff-
goingsdlaborsdnurse'ssdobservationssdweresdcorrect?
Askingsdthesdwomansdtosddescribesdhersdpainsdandsdratesditsdonsdasdscalesdofsd0sdtos
d10
Askingsdthesdvisitorssdinsdthesdroomsdifsdtheysdthinksdthesdwomansdissdexperienci
ngsdpain
Takingsdthesdwoman'ssdvitalsdsignssdandsdconsultingsdwithsdothersdstaffsdmemb
ers
Nosdadditionalsdassessmentssdaresdindicatedsduntilsdthesdwomansdbeginssdtosdre
portsdpain.sd-sdcorrectsdanswer✔ ✔
Askingsdthesdvisitorssdinsdthesdroomsdifsdtheysdthinksdthesdwomansdissdexperie
ncingsdpain
Generalsdanesthesiasdissdnotsdusedsdfrequentlysdinsdobstetricssdbecausesdofsdthes
driskssdinvolved.sdTheresdaresdphysiologicsdchangessdthatsdoccursdduringsdpreg
nancysdthatsdmakesdthesdriskssdofsdgeneralsdanesthesiasdhighersdthansditsdissdinsdth
esdgeneralsdpopulation.sdWhatsdissdonesdofsdthosesdrisks?
Thesdclientsdissdmoresdsensitivesdtosdpreanestheticsdmedications.
Thesdclientsdissdlesssdsensitivesdtosdinhalationsdanesthetics.
,Neonatalsddepressionsdissdpossible.
Fetalsdhypersensitivitysdtosdanestheticsdissdpossible.sd-sdcorrectsdanswer✔ ✔
Neonatalsddepressionsdissdpossible
Asdwoman'ssdhusbandsdexpressessdconcernsdaboutsdrisksdofsdparalysissdfromsda
nsdepiduralsdblocksdbeingsdgivensdtosdhissdwife.sdWhichsdwouldsdbesdthesdmostsda
ppropriatesdresponsesdbysdthesdnurse?
"Ansdinjurysdissdunlikelysdbecausesdofsdexpertsdprofessionalsdcaresdgiven."
"Isdhavesdneversdreadsdorsdheardsdofsdthissdhappening."
"Thesdinjectionsdissdgivensdinsdthesdspacesdoutsidesdthesdspinalsdcord."
"Thesdinjectionsdissdgivensdatsdthesdthirdsdorsdfourthsdthoracicsdvertebraesdsosdpar
alysissdissdnotsdasdproblem."sd-sdcorrectsdanswer✔ ✔
"Thesdinjectionsdissdgivensdinsdthesdspacesdoutsidesdthesdspinalsdcord."
Asdwomansdinsdlaborsdwhosdreceivedsdansdopioidsdforsdpainsdreliefsddevelopssdre
spiratorysddepression.sdThesdnursesdwouldsdexpectsdwhichsdagentsdtosdbesdadmi
nistered?
butorphanol
fentanyl
naloxone
promethazinesd-sdcorrectsdanswer✔ ✔ Naloxone
, Asdclientsdinsdlaborsdhassdbeensdgivensdansdepiduralsdanesthetic.sdWhichsdnursin
gsdassessmentsdfindingsdissdmostsdimportantsdimmediatelysdfollowingsdthesdad
ministrationsdofsdepiduralsdanesthesia?
Maternalsdrespirationssddecreasesdfromsd20sdtosd14sdbreaths/minute.
Maternalsdbloodsdpressuresddecreasessdfromsd130/70sdtosd98/50sdmmsdHg.
Maternalsdpulsesdincreasessdfromsd78sdtosd96sdbeats/minute.
Maternalsdtemperaturesdincreasessdfromsd99°sdFsd(37.2°sdC)sdtosd100°sdFsd(37.8
°sdC).sd-sdcorrectsdanswer✔ ✔
Maternalsdbloodsdpressuresddecreasessdfromsd130/70sdtosd98/50sdmmsdHg.
Asdclientsdinsdactivesdlaborsdissdgivensdspinalsdanesthesia.sdWhichsdinformations
dwouldsdthesdnursesdincludesdwhensddiscussingsdwithsdthesdclientsdandsdfamilysd
aboutsdthesddisadvantagessdofsdspinalsdanesthesia?
passagesdofsdthesddrugsdtosdthesdfetus
headachesdfollowingsdanesthesia
excessivesdcontractionssdofsdthesduterus
increasedsdfrequencysdofsdmicturitionsd-sdcorrectsdanswer✔ ✔
headachesdfollowingsdanesthesia
Asdclientsdwhosdrequestedsd"nosddrugs"sdinsdlaborsdaskssdthesdnursesdwhatsdother
sdoptionssdaresdavailablesdforsdpainsdrelief.sdThesdnursesdreviewssdseveralsdoptio
nssdforsdnonpharmacologicsdpainsdrelief,sdandsdthesdclientsdthinkssdeffleuragesd
maysdhelpsdhersdmanagesdthesdpain.sdThissdindicatessdthatsdthesdnursesdwill:
leadsdthesdclientsdthroughsdasdseriessdofsdvisualizationssdtosdaidsdinsdrelaxation.
sd sd sd sd sd
abor and Birth
sd sd
Thesdlaborsdnursesdreportssdtosdthesdnursesdonsdthesdoncomingsdshift,sd"Thesdwo
mansdinsdlaborsdroomsd2sdissdhandlingsdhersdpainsdverysdwell.sdShesdsmilessdwhe
neversdIsdgosdinsdtosdtalksdtosdher,sdandsdshesddoesn'tsdcomplainsdatsdall!"sdWhatsda
ssessmentsdbysdthesdoncomingsdlaborsdnursesdwouldsdbestsdrevealsdifsdthesdoff-
goingsdlaborsdnurse'ssdobservationssdweresdcorrect?
Askingsdthesdwomansdtosddescribesdhersdpainsdandsdratesditsdonsdasdscalesdofsd0sdtos
d10
Askingsdthesdvisitorssdinsdthesdroomsdifsdtheysdthinksdthesdwomansdissdexperienci
ngsdpain
Takingsdthesdwoman'ssdvitalsdsignssdandsdconsultingsdwithsdothersdstaffsdmemb
ers
Nosdadditionalsdassessmentssdaresdindicatedsduntilsdthesdwomansdbeginssdtosdre
portsdpain.sd-sdcorrectsdanswer✔ ✔
Askingsdthesdvisitorssdinsdthesdroomsdifsdtheysdthinksdthesdwomansdissdexperie
ncingsdpain
Generalsdanesthesiasdissdnotsdusedsdfrequentlysdinsdobstetricssdbecausesdofsdthes
driskssdinvolved.sdTheresdaresdphysiologicsdchangessdthatsdoccursdduringsdpreg
nancysdthatsdmakesdthesdriskssdofsdgeneralsdanesthesiasdhighersdthansditsdissdinsdth
esdgeneralsdpopulation.sdWhatsdissdonesdofsdthosesdrisks?
Thesdclientsdissdmoresdsensitivesdtosdpreanestheticsdmedications.
Thesdclientsdissdlesssdsensitivesdtosdinhalationsdanesthetics.
,Neonatalsddepressionsdissdpossible.
Fetalsdhypersensitivitysdtosdanestheticsdissdpossible.sd-sdcorrectsdanswer✔ ✔
Neonatalsddepressionsdissdpossible
Asdwoman'ssdhusbandsdexpressessdconcernsdaboutsdrisksdofsdparalysissdfromsda
nsdepiduralsdblocksdbeingsdgivensdtosdhissdwife.sdWhichsdwouldsdbesdthesdmostsda
ppropriatesdresponsesdbysdthesdnurse?
"Ansdinjurysdissdunlikelysdbecausesdofsdexpertsdprofessionalsdcaresdgiven."
"Isdhavesdneversdreadsdorsdheardsdofsdthissdhappening."
"Thesdinjectionsdissdgivensdinsdthesdspacesdoutsidesdthesdspinalsdcord."
"Thesdinjectionsdissdgivensdatsdthesdthirdsdorsdfourthsdthoracicsdvertebraesdsosdpar
alysissdissdnotsdasdproblem."sd-sdcorrectsdanswer✔ ✔
"Thesdinjectionsdissdgivensdinsdthesdspacesdoutsidesdthesdspinalsdcord."
Asdwomansdinsdlaborsdwhosdreceivedsdansdopioidsdforsdpainsdreliefsddevelopssdre
spiratorysddepression.sdThesdnursesdwouldsdexpectsdwhichsdagentsdtosdbesdadmi
nistered?
butorphanol
fentanyl
naloxone
promethazinesd-sdcorrectsdanswer✔ ✔ Naloxone
, Asdclientsdinsdlaborsdhassdbeensdgivensdansdepiduralsdanesthetic.sdWhichsdnursin
gsdassessmentsdfindingsdissdmostsdimportantsdimmediatelysdfollowingsdthesdad
ministrationsdofsdepiduralsdanesthesia?
Maternalsdrespirationssddecreasesdfromsd20sdtosd14sdbreaths/minute.
Maternalsdbloodsdpressuresddecreasessdfromsd130/70sdtosd98/50sdmmsdHg.
Maternalsdpulsesdincreasessdfromsd78sdtosd96sdbeats/minute.
Maternalsdtemperaturesdincreasessdfromsd99°sdFsd(37.2°sdC)sdtosd100°sdFsd(37.8
°sdC).sd-sdcorrectsdanswer✔ ✔
Maternalsdbloodsdpressuresddecreasessdfromsd130/70sdtosd98/50sdmmsdHg.
Asdclientsdinsdactivesdlaborsdissdgivensdspinalsdanesthesia.sdWhichsdinformations
dwouldsdthesdnursesdincludesdwhensddiscussingsdwithsdthesdclientsdandsdfamilysd
aboutsdthesddisadvantagessdofsdspinalsdanesthesia?
passagesdofsdthesddrugsdtosdthesdfetus
headachesdfollowingsdanesthesia
excessivesdcontractionssdofsdthesduterus
increasedsdfrequencysdofsdmicturitionsd-sdcorrectsdanswer✔ ✔
headachesdfollowingsdanesthesia
Asdclientsdwhosdrequestedsd"nosddrugs"sdinsdlaborsdaskssdthesdnursesdwhatsdother
sdoptionssdaresdavailablesdforsdpainsdrelief.sdThesdnursesdreviewssdseveralsdoptio
nssdforsdnonpharmacologicsdpainsdrelief,sdandsdthesdclientsdthinkssdeffleuragesd
maysdhelpsdhersdmanagesdthesdpain.sdThissdindicatessdthatsdthesdnursesdwill:
leadsdthesdclientsdthroughsdasdseriessdofsdvisualizationssdtosdaidsdinsdrelaxation.
