NURS 326 - Exam 2 - All objective answered
COMPREHENSIVE LECTURE NOTES: ALL
OBJECTIVES AND QUESTIONS ANSWERED
WITH NURSING RESPONSIBILITIES
UNIT 1: PAIN MANAGEMENT
DURING CHILDBIRTH (Chapter 17)
OBJECTIVE 1: Describe the physiologic effects
of pain during labor and the nursing
responsibilities
PHYSIOLOGIC EFFECTS OF PAIN:
Effect Pathophysiology NURSING RESPONSIBILITY
Increased Pain stimulates sympathetic nervous Monitor maternal respiratory rate;
oxygen system → increased metabolic rate → assess for signs of hyperventilation;
demand increased O2 consumption administer O2 if needed
Catecholamine release (epinephrine,
Altered Position mother in lateral position;
norepinephrine) → decreased uterine
placental avoid supine position; monitor FHR
blood flow → reduced O2 delivery to
exchange for decelerations
fetus
Slow, deep, poorly localized pain Provide nonpharmacologic comfort
Visceral from uterine contractions (tissue measures; effleurage; breathing
pain ischemia) and cervical dilatation; techniques; support; analgesic
dominates FIRST stage administration in active phase
Fast, sharp, precisely located pain
from descending fetus pressing on Prepare for regional anesthesia;
Somatic
maternal tissues, distention of perineal support during pushing;
pain
vagina/perineum; dominates guided pushing techniques
TRANSITION and SECOND stage
,NURS 326 - Exam 2 - All objective answered
OBJECTIVE 2: Identify the adverse effects of
excessive pain and nursing interventions
ADVERSE EFFECTS AND NURSING INTERVENTIONS:
Effect Manifestation NURSING INTERVENTION
Monitor VS q1h latent, q30min active,
Increased Maternal tachycardia,
q15min transition; encourage rest
metabolic rate tachypnea
between contractions
Position changes (L lateral); IV fluids;
Increased Decreased uterine blood
pain management; continuous FHR
catecholamines flow, prolonged labor
monitoring
Increased Monitor blood glucose in diabetic
Maternal hyperglycemia
cortisol/glucagon mothers; assess urine output
Non-reassuring FHR Implement intrauterine resuscitation: O2
Decreased fetal
patterns (late decels, 10L, position change, IV fluids, notify
O2 exchange
minimal variability) provider
Delayed attachment, Facilitate immediate skin-to-skin;
No interaction
decreased breastfeeding encourage breastfeeding within first
with infant
initiation hour; minimize separation
Negative birth perception, Provide continuous labor support;
Unpleasant
postpartum depression, fear explain procedures; encourage birth
memories
of future childbirth plan; debrief postpartum
Inadequate Include partner in care; teach partner
Partner feels helpless,
feelings of comfort measures (counterpressure,
uninvolved
partner massage); validate partner's role
,NURS 326 - Exam 2 - All objective answered
OBJECTIVE 3: List factors influencing pain
response and corresponding nursing
responsibilities
Factor Impact on Pain NURSING RESPONSIBILITY
Neurologic intactness, Assess fatigue level; promote rest; provide
Physiologic
fatigue, cervical readiness comfort measures; time analgesia
factors
affect pain perception appropriately
Expression of pain varies; Assess cultural beliefs; NEVER judge
Culture cultural expectations about response; provide culturally competent
"good" laboring woman care; use interpreter if needed
Fear-tension-pain syndrome; Reduce anxiety through education;
Anxiety anxiety increases muscle continuous presence; calm environment;
tension → increases pain explain all procedures
Prior negative birth → Assess previous birth experiences;
Previous
increased fear/pain; prior acknowledge fears; validate feelings; focus
experience
positive birth → confidence on differences this labor
Large diameter fibers (touch, Provide effleurage, massage,
Gate-control
pressure) can close "gate" to counterpressure, thermal stimulation; teach
theory
small diameter pain fibers partner these techniques
Address hygiene, positioning,
Physical discomfort
Comfort environment, elimination; offer warm
amplifies pain perception
blanket, back rub, lip moisturizer
Continuous support Provide continuous presence or ensure
Support decreases analgesia need, doula access; limit interruptions; minimize
C/S rates, labor length staff changes
Create calm, private environment; dim
Bright lights, noise,
Environment lights; quiet voices; limit visitors; protect
interruptions increase stress
from unnecessary interruptions
, NURS 326 - Exam 2 - All objective answered
OBJECTIVE 4: Describe nonpharmacologic
pain management techniques and nursing
responsibilities
Technique Description NURSING RESPONSIBILITY
Lamaze, Reinforce prenatally learned techniques;
Childbirth preparation Bradley, Dick- assess coping; provide cueing for breathing
Read methods patterns
Slow-paced,
modified- Teach/remind techniques; demonstrate;
Breathing techniques paced, breathe with patient; assess for
patterned- hyperventilation
paced
Excessive RECOGNIZE EARLY SIGNS:
respiratory rate lightheadedness, dizziness, tingling of
→ excessive fingers/lips, carpopedal
HYPERVENTILATION CO2 spasm. INTERVENE: Have woman
elimination → breathe into cupped hands or paper bag;
respiratory slow breathing rate; rebreathing CO2
alkalosis restores acid-base balance
Light circular Teach technique; perform or have partner
Effleurage stroking of perform; distracts from pain; stimulates
abdomen large nerve fibers
Steady
Apply using fist or heel of hand; especially
pressure on
Counterpressure effective for back labor (OP position);
lower
have partner perform
back/sacrum
Distraction,
Assess music preference; provide
relaxation,
Music therapy headphones; create playlist; decreases
endorphin
anxiety
release
Buoyancy
Maintain water temp 37°C; monitor
relaxes
Water therapy maternal/fetal status; assist in/out of
muscles;
(hydrotherapy) tub; no hydrotherapy after ROM in
warmth
some institutions
decreases pain
COMPREHENSIVE LECTURE NOTES: ALL
OBJECTIVES AND QUESTIONS ANSWERED
WITH NURSING RESPONSIBILITIES
UNIT 1: PAIN MANAGEMENT
DURING CHILDBIRTH (Chapter 17)
OBJECTIVE 1: Describe the physiologic effects
of pain during labor and the nursing
responsibilities
PHYSIOLOGIC EFFECTS OF PAIN:
Effect Pathophysiology NURSING RESPONSIBILITY
Increased Pain stimulates sympathetic nervous Monitor maternal respiratory rate;
oxygen system → increased metabolic rate → assess for signs of hyperventilation;
demand increased O2 consumption administer O2 if needed
Catecholamine release (epinephrine,
Altered Position mother in lateral position;
norepinephrine) → decreased uterine
placental avoid supine position; monitor FHR
blood flow → reduced O2 delivery to
exchange for decelerations
fetus
Slow, deep, poorly localized pain Provide nonpharmacologic comfort
Visceral from uterine contractions (tissue measures; effleurage; breathing
pain ischemia) and cervical dilatation; techniques; support; analgesic
dominates FIRST stage administration in active phase
Fast, sharp, precisely located pain
from descending fetus pressing on Prepare for regional anesthesia;
Somatic
maternal tissues, distention of perineal support during pushing;
pain
vagina/perineum; dominates guided pushing techniques
TRANSITION and SECOND stage
,NURS 326 - Exam 2 - All objective answered
OBJECTIVE 2: Identify the adverse effects of
excessive pain and nursing interventions
ADVERSE EFFECTS AND NURSING INTERVENTIONS:
Effect Manifestation NURSING INTERVENTION
Monitor VS q1h latent, q30min active,
Increased Maternal tachycardia,
q15min transition; encourage rest
metabolic rate tachypnea
between contractions
Position changes (L lateral); IV fluids;
Increased Decreased uterine blood
pain management; continuous FHR
catecholamines flow, prolonged labor
monitoring
Increased Monitor blood glucose in diabetic
Maternal hyperglycemia
cortisol/glucagon mothers; assess urine output
Non-reassuring FHR Implement intrauterine resuscitation: O2
Decreased fetal
patterns (late decels, 10L, position change, IV fluids, notify
O2 exchange
minimal variability) provider
Delayed attachment, Facilitate immediate skin-to-skin;
No interaction
decreased breastfeeding encourage breastfeeding within first
with infant
initiation hour; minimize separation
Negative birth perception, Provide continuous labor support;
Unpleasant
postpartum depression, fear explain procedures; encourage birth
memories
of future childbirth plan; debrief postpartum
Inadequate Include partner in care; teach partner
Partner feels helpless,
feelings of comfort measures (counterpressure,
uninvolved
partner massage); validate partner's role
,NURS 326 - Exam 2 - All objective answered
OBJECTIVE 3: List factors influencing pain
response and corresponding nursing
responsibilities
Factor Impact on Pain NURSING RESPONSIBILITY
Neurologic intactness, Assess fatigue level; promote rest; provide
Physiologic
fatigue, cervical readiness comfort measures; time analgesia
factors
affect pain perception appropriately
Expression of pain varies; Assess cultural beliefs; NEVER judge
Culture cultural expectations about response; provide culturally competent
"good" laboring woman care; use interpreter if needed
Fear-tension-pain syndrome; Reduce anxiety through education;
Anxiety anxiety increases muscle continuous presence; calm environment;
tension → increases pain explain all procedures
Prior negative birth → Assess previous birth experiences;
Previous
increased fear/pain; prior acknowledge fears; validate feelings; focus
experience
positive birth → confidence on differences this labor
Large diameter fibers (touch, Provide effleurage, massage,
Gate-control
pressure) can close "gate" to counterpressure, thermal stimulation; teach
theory
small diameter pain fibers partner these techniques
Address hygiene, positioning,
Physical discomfort
Comfort environment, elimination; offer warm
amplifies pain perception
blanket, back rub, lip moisturizer
Continuous support Provide continuous presence or ensure
Support decreases analgesia need, doula access; limit interruptions; minimize
C/S rates, labor length staff changes
Create calm, private environment; dim
Bright lights, noise,
Environment lights; quiet voices; limit visitors; protect
interruptions increase stress
from unnecessary interruptions
, NURS 326 - Exam 2 - All objective answered
OBJECTIVE 4: Describe nonpharmacologic
pain management techniques and nursing
responsibilities
Technique Description NURSING RESPONSIBILITY
Lamaze, Reinforce prenatally learned techniques;
Childbirth preparation Bradley, Dick- assess coping; provide cueing for breathing
Read methods patterns
Slow-paced,
modified- Teach/remind techniques; demonstrate;
Breathing techniques paced, breathe with patient; assess for
patterned- hyperventilation
paced
Excessive RECOGNIZE EARLY SIGNS:
respiratory rate lightheadedness, dizziness, tingling of
→ excessive fingers/lips, carpopedal
HYPERVENTILATION CO2 spasm. INTERVENE: Have woman
elimination → breathe into cupped hands or paper bag;
respiratory slow breathing rate; rebreathing CO2
alkalosis restores acid-base balance
Light circular Teach technique; perform or have partner
Effleurage stroking of perform; distracts from pain; stimulates
abdomen large nerve fibers
Steady
Apply using fist or heel of hand; especially
pressure on
Counterpressure effective for back labor (OP position);
lower
have partner perform
back/sacrum
Distraction,
Assess music preference; provide
relaxation,
Music therapy headphones; create playlist; decreases
endorphin
anxiety
release
Buoyancy
Maintain water temp 37°C; monitor
relaxes
Water therapy maternal/fetal status; assist in/out of
muscles;
(hydrotherapy) tub; no hydrotherapy after ROM in
warmth
some institutions
decreases pain
