Download Promoting Patient Comfort

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Chapter 13
Promoting Patient Comfort During
Labor and Birth
Edited by Catherine Marin, MSN/Ed©, WHCNP, RN
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pain During Labor and Birth
 Shaped by past experiences
 Assessing pain
 Physiological, psychological indicators
 Patient responses
 May be intensified by fear, anxiety, fatigue
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Physical Causes of Pain
Labor and Birth
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pain Neurology
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Uterine ischemia
Visceral pain—dull and aching
Referred pain
Somatic pain—sharp, burning, prickling
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pain Perception and Expression
 Highly personal and subjective
 Affected by gender, culture, ethnicity, and
past experiences
 Physiological/affective expression
 Increased catecholamines
 Increased blood pressure and heart rate
 Altered respiratory pattern
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Factors Affecting
Maternal Pain Response
 Physical
 Physiological
 Psychological
 Anxiety, fear, previous experience
 Support systems, childbirth preparation
 Environmental
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pain Pathways and Childbirth
 Multidimensional phenomenon
 Affective, physiologic, behavioral, sensory,
cognitive
 Neural pathway for pain
 Gate-control theory
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Benefits of Comfort and
Support
Pain Perception
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nonpharmacological
Pain Relief Measures
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Maternal position and movement
Breathing techniques
Music
Relaxation techniques
Other attention-focusing strategies
 Guided imagery
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Massage and Touch
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Effleurage
Counterpressure
Therapeutic touch
Healing touch
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Other Therapies for Comfort
 Hydrotherapy, hypnotherapy,
aromatherapy
 Application of heat and cold
 Biofeedback, TENS, intradermal water
block
 Acupressure/acupuncture
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pharmacological Pain
Relief Measures
 Timing
 Nonpharmacological and pharmacological
measures promote positive experience
 Informed consent
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Pharmacological Measures
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Sedatives and antiemetics
Barbiturates
Benzodiazepines
H1-Receptor antagonists
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Analgesics and Anesthetics
 Systemic
 Opiod agonist analgesics
 Opiod agonist-antagonist analgesics
 Opiod antagonists
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Nerve Block Analgesia,
Anesthesia
 Regional anesthesia
 Local perineal infiltration anesthesia
 Pudendal nerve block
 Spinal anesthesia block
 Complications: maternal hypotension, decreased
placental perfusion, ineffective breathing pattern
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Postdural Puncture Headache
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Leakage of cerebrospinal fluid
Intensified in upright position
Auditory and visual problems
Autologous epidural blood patch
 Discharge instructions
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Epidural Anesthesia or
Analgesia Block
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Local anesthetic—epidural space
Pain relief from contractions
Pain relief from birth
Opioid and local anesthetic agent
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Lumbar Epidural
 Advantages
 Minimal trauma to fetal skull
 No fetal respiratory depression
 Complication
 Maternal hypotension
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Maternal Hypotension
 Prevention
 Preload IV fluids
 Requires constant nursing attendance
 Monitor vital signs
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Disadvantages of Epidural
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Limited mobility
Common side effects
Accidental injection into blood vessel
Sympathetic blockage
Urinary retention, bladder distention
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Other Nerve Blocks
 Combined spinal-epidural analgesia
 Epidural and intrathecal opioids
 Ongoing nursing assessments essential
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
General Anesthesia
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Major risks
Pre-operative preparation
Cricoid pressure
Anesthetic gases and medications
Recovery room nursing care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Care Related
to Comfort Measures
 Assessment
 Ongoing and collaborative
 Diagnoses
 Anxiety
 Ineffective coping
 Acute pain
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Care
 Expected outcomes
 Plan of care
 Individualized
 Modified as needed
 Collaborative approach
Susan Ward
Shelton Hisley