Management of Labor Discomfort
Management of Labor Discomfort NSG 330
Popular in Maternal Infant
Popular in Nursing and Health Sciences
This 5 page Class Notes was uploaded by Brieanna Phipps on Monday March 14, 2016. The Class Notes belongs to NSG 330 at University of North Carolina - Wilmington taught by Dr. Goff in Spring 2016. Since its upload, it has received 14 views. For similar materials see Maternal Infant in Nursing and Health Sciences at University of North Carolina - Wilmington.
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Date Created: 03/14/16
Management of Labor Discomfort- Factors Influencing Pain- o Perception o Expression o Physiology o Culture o Anxiety o Previous Experience o Environment o Comfort o Support Non pharmacologic comfort measures o Support, explanations o Frequent mouth care o Change linens o Cool cloth on forehead o Encourage frequent voiding, catheterize as necessary 30 ml every hour; check bladder at least every 2 hours If bladder is too full o Position changes, birthing ball o Protect privacy and modesty Nonpharmacological management- o Cognitive Strategies: Childbirth Education---Focusing, Relaxation, Breathing Hypnosis Biofeedback o Breathing Techniques- Slow-paced: 6-8 per minute; not less than half normal breathing***; latent into active; IN 2 3 4, OUT 2, 3, 4 Works best in LATENT into ACTIVE phase Modified-paced: 32-40 breaths per minute; not more than twice normal breaths; active into transition; IN OUT IN OUT Patterned-paced: same rate as modified; 3:1, 4:1; - the one is a big breathe out, so 3 short blows out and 1 big blow out enhances concentration; transition phase Cleansing breath first for all 3; at the start of a contraction and at end Can combine slow and modified-paced Do these during a contraction not really in between o Sensory Stimulation Strategies: Aromatherapy Breathing Techniques Music Imagery Focal Points o Cutaneous Stimulation Strategies: Counterpressure Use fist or tennis ball to press on lower back Effleurage Massage center to outer (abd) Very light touch Relaxes abd. Therapeutic Touch and Massage Must be trained to do this Walking Rocking o Application of Heat or Cold Must be careful culturally o Transcutaneous Electrical Nerve Stimulation (TENS) 2 pairs of electrodes Low intensity waves of electricity Battery operated, mother can turn to high during contraction and low when over Helps in latent into active phase Low back pain o Acupressure o Water Therapy o Intradermal Water Block 0.1 ml of sterile water injected Pic on slide 19 Works for about 45 mins to 2 hours; used in early labor Pharmacologic Management- o Epidural (Block) Analgesia Used for regular virginal labors Usually injected in the active phase of the first stage (can be given during transition but for multigravida may be too late b/c not enough time) Can slow down labor at first HYPOTENSION- load mother up with IV fluid o Spinal (Block) Analgesia Usually used for a C-Section Cannot be given until late in the first stage (must be fully dilated) May get headache b/c spinal fluid leaks outs o Combined Spinal-Epidural (CSE) Analgesia (“Walking Epidural”) Puncture the dura first for the spinal then pull back to leave catheter in the epidural space o Sedatives o Systemic Analgesia: o Opioid Agonist Analgesics o Opioid Agonist-Antagonist Analgesics o Opioid Antagonists o Pudendal Block o Local Infiltration Analgesia o Nitrous Oxide (Canada & Europe) o General Anesthesia o o Intrathecal- o Newer technique o Same place and technique as epidural o Same prerequisites o Very small dose of an opiate (usually morphine) or an opiate mixed with local anesthetic Fentanyl Sufantynl Or a combination of the 2 o Toxic effects minimal; possible itching and nausea o Better fetal tolerance; mother more relaxed; feels urge to push; progresses well o This is a one shot deal o Side effects are a lot less than with epidural or spinal block Baby and mother tolerate it better Possible Complications- o Maternal Hypotension With Decreased Placental Perfusion o Postdural Puncture Headache (PDPH) o Fetal Bradycardia (Combined SE) o Urinary Retention and Stress Incontinence o Elevated Temperature (Epidural) o Dizziness, Sedation, and Weakness of Legs o CNS Effects o Respiratory Arrest Maternal Hypotension Interventions-************ o Turn woman to lateral position, or place pillow or wedge under hip to displace uterus o Maintain IV per order and protocol o Administer O2 by face mask at 10 to 12 L/min or per protocol o Elevate legs o Notify health care provider and anesthesia professional o Administer IV vasopressor per protocol if above measures ineffective o Remain with woman o Continue to monitor BP & FHR every 5 minutes until stable and per order PDPH Treatment- o Oral Analgesics o Bed rest in quiet dimly lit or dark room o Caffeine o Increased fluid intake o May keep flat for at least 8 hours past administration of spinal anesthesia o Epidural blood patch if necessary General Nursing Care – o Assess factors influencing pain response o Provide comfort and support o Decrease stimuli in environment o Encourage nonpharmacologic management of discomfort o Promote relaxation and breathing techniques o Explain advantages and disadvantages of pharmacologic options o Have patient empty bladder before epidural, spinal, or combination, and empty every 2 hours thereafter o Monitor vital signs, especially BP, and fetal heart rate per protocol o Monitor effects of anesthesia or analgesia during labor and postpartum
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