Question 1

After a change-of-shift report the nurse assumes care of a multiparous patient in labour.The woman is complaining of pain that radiates to her abdominal wall,lower back,and buttocks and down her thighs.Which type of pain is the woman experiencing?

Accepted Answer

As labour progresses,the woman often experiences referred pain.This occurs when pain that originates in the uterus radiates to the abdominal wall,the lumbosacral area of the back,the gluteal area,and thighs.The woman usually has pain only during a contraction and is free from pain between contractions.Visceral pain is that which predominates during the first stage of labour.This pain originates from cervical changes,distension of the lower uterine segment,and uterine ischemia.Visceral pain is located over the lower portion of the abdomen.Somatic pain is described as intense,sharp,burning,and well localized.This results from stretching of the perineal tissues and the pelvic floor.This occurs during the second stage of labour.Pain experienced during the third stage of labour or afterward during the early postpartum period is uterine.This pain is very similar to that experienced in the first stage of labour.

Question 2

What should nurses be aware of with regard to nerve block analgesia and anaesthesia?

Accepted Answer

Most local agents are chemically related to cocaine and end in the suffix -caine,such as lidocaine and chloroprocaine.Injections can be repeated to prolong the anaesthesia.A pudendal nerve block relieves pain in the vagina,vulva,and perineum but not the pain from uterine contractions,and it lessens or shuts down the bearing-down reflex.

Question 3

A woman in labour is breathing into a mouthpiece just before the start of her regular contractions.As she inhales,a valve opens,and gas is released.She continues to inhale the gas slowly and deeply until the contraction starts to subside.When the inhalation stops,the valve closes.Which statement is accurate in relation to this scenario?

Accepted Answer

This is an application of nitrous oxide,which could be used in either the first or second stage of labour (or both)as part of the preparation for a vaginal birth.

Question 4

What should the nurse be cognizant of with regard to spinal and epidural anaesthesia?

Accepted Answer

Headaches may be prevented or mitigated to some degree by a number of methods.Spinal blocks may be used for vaginal births,but the woman must be assisted through labour.Epidural blocks limit the woman's ability to move freely.Combined use of spinal and epidural blocks is becoming increasingly popular.

Question 5

Maternal hypotension is a potential adverse effect of regional anaesthesia and analgesia.Which nursing intervention would the nurse use to raise the patient's blood pressure?

Accepted Answer

Nursing interventions for maternal hypotension arising from analgesia or anaesthesia include turning the woman to a lateral position,increasing IV fluids,administering oxygen via face mask,elevating the woman's legs,notifying the physician,administering an IV vasopressor,and monitoring the maternal and fetal status at least every 5 minutes until both are stable.Placing the patient in a supine position would cause venous compression,thereby limiting blood flow to and oxygenation of the placenta and fetus.A sterile vaginal examination has no bearing on maternal blood pressure.Electronic monitoring will not affect maternal hypotension.

Question 6

Which interventions are appropriate when caring for a woman with maternal hypotension who has a spinal anaesthesia? Select all that apply.Express answer with small letters,followed by a comma and a space-e.g. ,a,b,C

Accepted Answer

Interventions for maternal hypotension are turning the woman to a lateral position or placing a wedge under her hip;maintaining or increasing IV fluid;administering oxygen by non-breather face mask at 10 to 12 L/min;notifying the primary health care provider;administering IV vasopressor as ordered;and monitoring maternal blood pressure and fetal heart rate every 5 minutes.

Question 7

What should nurses be aware of with regard to systemic analgesics administered during labour?

Accepted Answer

Opioids readily cross the placenta.Effects on the fetus and the newborn can be profound,including absent or minimal FHR variability during labour and significant neonatal respiratory depression requiring treatment after birth.Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier.IV administration is preferred over IM administration because the drug acts faster and more predictably.PCA results in decreased use of an analgesic.

Quiz 18: Pain Management During Labour