Maternal-Infant Final Study Guide NUR 316
updated Exam Review
Pain Relief Measure Used in Labor
• Theories of Pain
o Gate control theory
▪ Pain can be controlled by tactile stimulation and modified by activities
controlled by CNS (backrub, effleurage, suggestion, distraction, and
conditioning)
o Endorphins – released when you feel pain
▪ Endogenous morphine – if endorphins are released pain will be decreased
– relaxed environment and positive thoughts. Endorphin levels act on
central and peripheral system to decrease pain
• Sources of Pain
o First stage – cervical dilation causes visceral pain – contractions
o Second stage – perineal pressure on structures, stretching, burning (somatic pain)
o Factors affecting response to pain
▪ Culture
▪ Fatigue/sleep deprivation – less pain tolerance and reserve
▪ Previous experience-coping mechanisms for pain past experiences
▪ Anxiety-mild good for focusing, excessive causes catecholamine secretion
which increases stimuli to brain causing fear, muscle tension, increased
discomfort
• Psychoprophylaxis
o Lamaze – grew from Pavlov’s work on conditioning
▪ Relaxation techniques relax all muscle groups
▪ Breathing patterns
▪ Effleurage – light stroking of the abdomen, thigh or chest
▪ Water therapy buoyancy and warmth fosters relaxation
▪ Husband helps as a coach
o Other methods
▪ Grantley Dick-Read-3 techniques – exercise, relaxation, breathing techniques
▪ Bradley-husband coached childbirth-relaxed, quiet, slow breathing controlled
▪ Hypnosis (Hypno birthing)
▪ Positioning-pillows, support
▪ Transcutaneous Electrical Nerve Stimulation (TENS) – based on gate
control theory
• Analgesia (IV, IM)
o Goal: patient has maximum pain, relief at minimal risk to mother and fetus. Patient
is conscious but sedated and retains full motor function.
▪ Check patients labor status before you give narcotic!
▪ Know dilation status because narcotics pass placenta so they cause depression
of respirations in baby.
• Systemic Analgesia
o Narcotics-all narcotics may cause respiratory depression in mom and/or CNS
depression in fetus
▪ Meperidine HCL (Demerol) may be given IV or IM in 1st stage of labor
▪ Fentanyl (Sublimaze) may be given IV or IM in 1st stage of labor
o Mixed narcotic agonist-antagonists
▪ Stadol may be given 0.5mg-2mg IV or IM 1st stage
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
,Maternal-Infant Final Study Guide NUR 316
updated Exam Review
▪ Nubain 5-10 mg IV or IM in 1st stage of labor. Only until 4 cm without order
causes nausea give Phenergan with it but really makes you feel “out of it”
o Analgesic Potentiators (ataractics)
▪ Do not decrease pain but decrease anxiety and apprehension and potentiate
the action of narcotics
• Phenothiazines – Phenergan, Compazine, vistaril, used to
promote relaxation, allay anxiety, control emesis, and potentiate
narcotic effects
o You can give a cocktail of two and it will work for about 6 hours, but can make them not
know what is going on. Ex. Nubain and Phenergan—works great together
▪ Narcotic Antagonists: Narcan reverses the action of narcotics both adults
and neonates
• Dose for infant – 0.01mg/kag IM, IV, SQ may be repeated
• Dose for adult – 0.1-0.2 mg IV q 2-3 minutes prn
• Sedatives and Tranquilizers
o Benzodiazepines – used more for a C-section mom
▪ Valium, versed-used to reduce anxiety, sedative/hypnotic (C-section)
o Butyrophenones
▪ Inapsine, Haldol – used to produce profound amnesia and post-op sedation
o Barbituates
▪ Seconal, pentobarbital – used to promote relaxation and sleep in early or
false labor.
• Nursing Care
o Maternal status
▪ Check BP, watch for decreased respirations, encourage rest between contractions
o Fetal status
▪ Note a decrease in beat to beat variability
▪ Try to administer narcotic IV during the contraction over appropriate time frame
narcotics effect babys variability
▪ Narcotics cross the placental barrier and affects fetal variability cause that’s
what affects baby CNS
o Labor status
▪ Relaxation fosters dilation
• Anesthesia
o A total loss of sensory capability, may be regional or centrally to brain (consciousness
is lost); usually implies that one or more vital organ functions are under partial or total
control of anesthesia provider. ONLY USED AS LAST RESORT don’t want to depress
mom because that depresses baby
o Regional Blocks – differentiate site of insertion in each type
o Check dilatation before medications are given because narcotics pass the placenta
barrier and affects baby’s status. If you give one when the mom is 8 cm dilated, it
will depress the babys CNS
o Typically greater than 4 cm dilated they have to get an epidural instead of narcotics
• Epidural Anesthesia
o Epidural: DOES NOT CROSS DURA MATER
▪ Advantages: mom alert and cooperative, only partial paralysis, gastric
emptying delay, blood loss minimal, decrease effect on fetus
▪ Disadvantages: maternal hypotension, need for IV, numbness heaviness of
legs, may make labor longer and increase pushing.
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
,Maternal-Infant Final Study Guide NUR 316
updated Exam Review
▪ Needles doesn’t cross dura. Spinal = crosses dura into dura space
▪ You give them fuids to increase fluid volume to get their BP up
▪ Feet are last to go away; start getting numb at feet first and then moves up so
when epidural is done; feet are last to get sensation; belly gets sensation
back first.
• Spinal Anesthesia CROSSES DURA AND GOES INTO DURA SPACE
o Spinal block: with spinal, takes minutes before whole bottom half is numb
▪ Advantages: good pain control, alert and awake, no respiratory effects
▪ Disadvantages: Marked hypotension, decreased cardiac output, spinal H/A,
loss of motor function and sensory function
• Complications – spinal H/A – constant H/A when HOB elevated, sx
alleviated when lying flat H/A = headache… doctors punctured spinal
space and fluid (CSF) leaked out. When CSF leaks out, brain stem
compresses. Treat with caffeine and blood patch to create a seal over
spinal space
• At least 1500 ml of fluid before to decrease hypotension; with the
spinal it takes less than one minute to become numb
• Brainstem compresses- severe headache when lays down it is
alleviated but when sit up more leakage of cerebrospinal fluid- the
spinal went through the spinal space causing fluid to come out
making patient get a spinal headache
• Nursing Care with Epidural Anesthesia
o Careful hemodynamic monitoring
▪ Assess BP q5 minutes at beginning of procedure and continue till 20
minutes after insertion of catheter. Longer if BP is decreased.
▪ Bolus with 1000ml of fluid, commonly Lactated Ringers solution, prior
to beginning procedure.
o Positioning
▪ Client is asked to sit at the side of the bed. Have client relax, drop shoulders,
use relaxation breathing during contractions
▪ Help client stay still and push lower back out towards the anesthesiologist;
push back out like a mad cow or like you are sucking in your stomachpushes
the lower back out
o Pudendal Block numbs the nerves that run along vaginal canal
▪ Advantages: alert, motor control, complete perineal anesthesia, no
maternal hemodynamic changes
▪ Disadvantages: lack pushing sensation, increase change of forceps or vacuum.
o Local infiltration numbness of area for epis, used at time of delivery-lidocaine and
is more for moms who don’t have other drugs, they can get lidocaine to numb for
episiotomy
▪ Advantages: rapid anesthesia 10 mins
▪ Disadvantages: none
o Use of epidural and intrathecal narcotics
▪ Short-acting
• Fentanyl or Sufenta-short term pain relief good for rapid
laboring patients
▪ Long-acting
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
, Maternal-Infant Final Study Guide NUR 316
updated Exam Review
• Morhpine (Duramorph or Astromorph – long-acting) these can
cause itching so you may have to give Benadryl and with
duramorph you have to check resp rate q hr because it can cause
resp depression
• Risks to mother and common side effects – respiratory
depression, decreased motor function, itching, dizziness.
• Essential nursing assessments – assess respiratory status
and sensorimotor status q 1hour every 24 hours
• Interventions – Benadryl, Nubain for itching
• There is a nation wide shortage of nubain so instead they are
giving morphine
o General Anesthesia – Emergencies only!
▪ IV anesthesia – NaPenthothal
▪ Complications
• Fetal depression – fast delivery
• Uterine relaxation – increase bleeding due to relaxation
• Vomiting and aspiration – Bicitra 30 mins before
• If assisting with an intubation you want to put cricoid pressure
(on trachea)
▪ Nursing Care
• Use of antacid (Bicitra)
• Positioning mother – assist intubation
▪ Types of Anesthetics
• Amides- Lidocaine, Mepivacaine, Bupivicaine (Marcaine):
more powerful and longer acting, placental transfer and affect
on fetus
• Esters – Procaine (novacaine), Nesacaine, Pontocaine:
Metabolize quickly, placental transfer
• WE ONLY USE GENERAL ANESTHESIA IN AN
EMERGENCY SITUATION OR IF SPINAL BLOCK DIDN’T
WORK- IT
SUPPRESSED BABY SO IF IT IS NOT WORKING SPINAL
THEY WOULD GET BABY OUT BEFORE GIVING
GENERAL ANESTHESIA
• Growth and Development/Infancy:
o Physical Changes
▪ Weight Gain:
• 1st 6 months: 1.5 #/month til 5 mos.
• Wt doubles by 6 mo; average 16 lbs.
• Triples by one year; avg is 21.5 lbs.
▪ Height
o Increases 1”/month for the first six months
o Average 25.5” at 6 months
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
updated Exam Review
Pain Relief Measure Used in Labor
• Theories of Pain
o Gate control theory
▪ Pain can be controlled by tactile stimulation and modified by activities
controlled by CNS (backrub, effleurage, suggestion, distraction, and
conditioning)
o Endorphins – released when you feel pain
▪ Endogenous morphine – if endorphins are released pain will be decreased
– relaxed environment and positive thoughts. Endorphin levels act on
central and peripheral system to decrease pain
• Sources of Pain
o First stage – cervical dilation causes visceral pain – contractions
o Second stage – perineal pressure on structures, stretching, burning (somatic pain)
o Factors affecting response to pain
▪ Culture
▪ Fatigue/sleep deprivation – less pain tolerance and reserve
▪ Previous experience-coping mechanisms for pain past experiences
▪ Anxiety-mild good for focusing, excessive causes catecholamine secretion
which increases stimuli to brain causing fear, muscle tension, increased
discomfort
• Psychoprophylaxis
o Lamaze – grew from Pavlov’s work on conditioning
▪ Relaxation techniques relax all muscle groups
▪ Breathing patterns
▪ Effleurage – light stroking of the abdomen, thigh or chest
▪ Water therapy buoyancy and warmth fosters relaxation
▪ Husband helps as a coach
o Other methods
▪ Grantley Dick-Read-3 techniques – exercise, relaxation, breathing techniques
▪ Bradley-husband coached childbirth-relaxed, quiet, slow breathing controlled
▪ Hypnosis (Hypno birthing)
▪ Positioning-pillows, support
▪ Transcutaneous Electrical Nerve Stimulation (TENS) – based on gate
control theory
• Analgesia (IV, IM)
o Goal: patient has maximum pain, relief at minimal risk to mother and fetus. Patient
is conscious but sedated and retains full motor function.
▪ Check patients labor status before you give narcotic!
▪ Know dilation status because narcotics pass placenta so they cause depression
of respirations in baby.
• Systemic Analgesia
o Narcotics-all narcotics may cause respiratory depression in mom and/or CNS
depression in fetus
▪ Meperidine HCL (Demerol) may be given IV or IM in 1st stage of labor
▪ Fentanyl (Sublimaze) may be given IV or IM in 1st stage of labor
o Mixed narcotic agonist-antagonists
▪ Stadol may be given 0.5mg-2mg IV or IM 1st stage
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
,Maternal-Infant Final Study Guide NUR 316
updated Exam Review
▪ Nubain 5-10 mg IV or IM in 1st stage of labor. Only until 4 cm without order
causes nausea give Phenergan with it but really makes you feel “out of it”
o Analgesic Potentiators (ataractics)
▪ Do not decrease pain but decrease anxiety and apprehension and potentiate
the action of narcotics
• Phenothiazines – Phenergan, Compazine, vistaril, used to
promote relaxation, allay anxiety, control emesis, and potentiate
narcotic effects
o You can give a cocktail of two and it will work for about 6 hours, but can make them not
know what is going on. Ex. Nubain and Phenergan—works great together
▪ Narcotic Antagonists: Narcan reverses the action of narcotics both adults
and neonates
• Dose for infant – 0.01mg/kag IM, IV, SQ may be repeated
• Dose for adult – 0.1-0.2 mg IV q 2-3 minutes prn
• Sedatives and Tranquilizers
o Benzodiazepines – used more for a C-section mom
▪ Valium, versed-used to reduce anxiety, sedative/hypnotic (C-section)
o Butyrophenones
▪ Inapsine, Haldol – used to produce profound amnesia and post-op sedation
o Barbituates
▪ Seconal, pentobarbital – used to promote relaxation and sleep in early or
false labor.
• Nursing Care
o Maternal status
▪ Check BP, watch for decreased respirations, encourage rest between contractions
o Fetal status
▪ Note a decrease in beat to beat variability
▪ Try to administer narcotic IV during the contraction over appropriate time frame
narcotics effect babys variability
▪ Narcotics cross the placental barrier and affects fetal variability cause that’s
what affects baby CNS
o Labor status
▪ Relaxation fosters dilation
• Anesthesia
o A total loss of sensory capability, may be regional or centrally to brain (consciousness
is lost); usually implies that one or more vital organ functions are under partial or total
control of anesthesia provider. ONLY USED AS LAST RESORT don’t want to depress
mom because that depresses baby
o Regional Blocks – differentiate site of insertion in each type
o Check dilatation before medications are given because narcotics pass the placenta
barrier and affects baby’s status. If you give one when the mom is 8 cm dilated, it
will depress the babys CNS
o Typically greater than 4 cm dilated they have to get an epidural instead of narcotics
• Epidural Anesthesia
o Epidural: DOES NOT CROSS DURA MATER
▪ Advantages: mom alert and cooperative, only partial paralysis, gastric
emptying delay, blood loss minimal, decrease effect on fetus
▪ Disadvantages: maternal hypotension, need for IV, numbness heaviness of
legs, may make labor longer and increase pushing.
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
,Maternal-Infant Final Study Guide NUR 316
updated Exam Review
▪ Needles doesn’t cross dura. Spinal = crosses dura into dura space
▪ You give them fuids to increase fluid volume to get their BP up
▪ Feet are last to go away; start getting numb at feet first and then moves up so
when epidural is done; feet are last to get sensation; belly gets sensation
back first.
• Spinal Anesthesia CROSSES DURA AND GOES INTO DURA SPACE
o Spinal block: with spinal, takes minutes before whole bottom half is numb
▪ Advantages: good pain control, alert and awake, no respiratory effects
▪ Disadvantages: Marked hypotension, decreased cardiac output, spinal H/A,
loss of motor function and sensory function
• Complications – spinal H/A – constant H/A when HOB elevated, sx
alleviated when lying flat H/A = headache… doctors punctured spinal
space and fluid (CSF) leaked out. When CSF leaks out, brain stem
compresses. Treat with caffeine and blood patch to create a seal over
spinal space
• At least 1500 ml of fluid before to decrease hypotension; with the
spinal it takes less than one minute to become numb
• Brainstem compresses- severe headache when lays down it is
alleviated but when sit up more leakage of cerebrospinal fluid- the
spinal went through the spinal space causing fluid to come out
making patient get a spinal headache
• Nursing Care with Epidural Anesthesia
o Careful hemodynamic monitoring
▪ Assess BP q5 minutes at beginning of procedure and continue till 20
minutes after insertion of catheter. Longer if BP is decreased.
▪ Bolus with 1000ml of fluid, commonly Lactated Ringers solution, prior
to beginning procedure.
o Positioning
▪ Client is asked to sit at the side of the bed. Have client relax, drop shoulders,
use relaxation breathing during contractions
▪ Help client stay still and push lower back out towards the anesthesiologist;
push back out like a mad cow or like you are sucking in your stomachpushes
the lower back out
o Pudendal Block numbs the nerves that run along vaginal canal
▪ Advantages: alert, motor control, complete perineal anesthesia, no
maternal hemodynamic changes
▪ Disadvantages: lack pushing sensation, increase change of forceps or vacuum.
o Local infiltration numbness of area for epis, used at time of delivery-lidocaine and
is more for moms who don’t have other drugs, they can get lidocaine to numb for
episiotomy
▪ Advantages: rapid anesthesia 10 mins
▪ Disadvantages: none
o Use of epidural and intrathecal narcotics
▪ Short-acting
• Fentanyl or Sufenta-short term pain relief good for rapid
laboring patients
▪ Long-acting
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
, Maternal-Infant Final Study Guide NUR 316
updated Exam Review
• Morhpine (Duramorph or Astromorph – long-acting) these can
cause itching so you may have to give Benadryl and with
duramorph you have to check resp rate q hr because it can cause
resp depression
• Risks to mother and common side effects – respiratory
depression, decreased motor function, itching, dizziness.
• Essential nursing assessments – assess respiratory status
and sensorimotor status q 1hour every 24 hours
• Interventions – Benadryl, Nubain for itching
• There is a nation wide shortage of nubain so instead they are
giving morphine
o General Anesthesia – Emergencies only!
▪ IV anesthesia – NaPenthothal
▪ Complications
• Fetal depression – fast delivery
• Uterine relaxation – increase bleeding due to relaxation
• Vomiting and aspiration – Bicitra 30 mins before
• If assisting with an intubation you want to put cricoid pressure
(on trachea)
▪ Nursing Care
• Use of antacid (Bicitra)
• Positioning mother – assist intubation
▪ Types of Anesthetics
• Amides- Lidocaine, Mepivacaine, Bupivicaine (Marcaine):
more powerful and longer acting, placental transfer and affect
on fetus
• Esters – Procaine (novacaine), Nesacaine, Pontocaine:
Metabolize quickly, placental transfer
• WE ONLY USE GENERAL ANESTHESIA IN AN
EMERGENCY SITUATION OR IF SPINAL BLOCK DIDN’T
WORK- IT
SUPPRESSED BABY SO IF IT IS NOT WORKING SPINAL
THEY WOULD GET BABY OUT BEFORE GIVING
GENERAL ANESTHESIA
• Growth and Development/Infancy:
o Physical Changes
▪ Weight Gain:
• 1st 6 months: 1.5 #/month til 5 mos.
• Wt doubles by 6 mo; average 16 lbs.
• Triples by one year; avg is 21.5 lbs.
▪ Height
o Increases 1”/month for the first six months
o Average 25.5” at 6 months
Maternal-Infant Final Study Guide NUR 316
updated Exam Review
