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OB Exam 2 Study Guide Already Graded A+ Pain Management During Labor Gate Control Theory - Pain travels along sensory nerve pathways, and only a limited number of sensations can be processed at one time. Distraction techniques can send alternate signals through these pathways, which can inhib...

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  • August 20, 2024
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OB Exam 2 Study Guide Already Graded A+
Pain Management During Labor



Gate Control Theory

- Pain travels along sensory nerve pathways, and only a limited number of sensations can be processed
at one time. Distraction techniques can send alternate signals through these pathways, which can inhibit
the perception of pain.



Non-Pharmacological Methods

- Early Labor:

- Cognitive Strategies: Doulas, hypnosis, biofeedback, and progressive relaxation.



- Back Pain:

- Sensory Stimulation: Aromatherapy, breathing techniques, imagery, music, focal points, and subdued
lighting.



- Active Labor/Transition:

- Cutaneous Stimulation: Therapeutic touch and massage, walking, rocking, effleurage, sacral
counterpressure, heat/cold application, TENS, hydrotherapy, acupressure/acupuncture, and maternal
position changes.



Pharmacological Methods

- Labor: Opioids, nitrous oxide, and epidurals.

- Cesarean Section: Spinal anesthesia and general anesthesia.

- Perineal/Episiotomy Repair: Local perineal infiltration anesthesia or pudendal nerve block.



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Complications and Nursing Interventions

,IV Narcotics

- Complications: Cross the placenta, potentially causing neonatal respiratory depression.

- Intervention: Administer Narcan (naloxone).



Epidurals

- Complications: Maternal hypotension.

- Interventions:

- Ensure IV access and administer a fluid bolus.

- Continuously monitor blood pressure and fetal heart rate.

- Have oxygen and ephedrine available for emergencies.



Spinals

- Complications: Maternal hypotension and fetal bradycardia.

- Interventions:

- Administer a 500-1000 mL bolus of Lactated Ringer's or Normal Saline before placement.

- Evaluate fetal heart rate immediately after administration.

- Monitor respiratory rate and pulse oximetry every hour.



General Anesthesia

- Complications: Postoperative pain.

- Interventions:

- Set up a Patient-Controlled Analgesia (PCA) pump.

- Assess readiness for bonding with the baby.

- Place a wedge under the left hip during administration.



---



Induction and Augmentation of Labor

- Induction: Done for non-medical reasons, such as convenience, maternal fears, or discomfort.

, - Augmentation: Performed when labor has started spontaneously but is progressing unsatisfactorily.



Medications for Labor Induction

- Cytotec (Misoprostol): Used for cervical ripening, applied near the cervix; cannot be removed and may
cause uterine tachysystole.

- Cervidil (Dinoprostone): Used for cervical ripening, removable after 12 hours or when labor begins;
may also cause uterine tachysystole.

- Pitocin (Oxytocin): Stimulates uterine contractions; requires careful monitoring and consideration of
potential complications.



Assessment Readiness for Induction

- Bishop Score: Must score at least 8 to evaluate cervical readiness and predict labor success.



---



Infertility

- Common causes: Past cancers, irregular periods, smoking, drinking, history of STDs, age, and obesity.

- Testing Options:

- Women: Hormone testing, pelvic ultrasound, hysteroscopy, hysterosalpingography (least to most
invasive).

- Men: Semen analysis, physical exam, hormone testing (least to most invasive).

- Treatment Options: Medical therapy, assisted reproductive technology (ART), surrogacy, and adoption.



Assisted Reproductive Technology (ART)

- Includes In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI).

- Medical Therapy: Clomid, progesterone, gonadotropins, FSH supplements, metformin.



Endometriosis

- Description: Tissue that normally lines the uterus grows outside it.

- Symptoms: Pelvic pain, dysmenorrhea, and painful intercourse.

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