Chapter_12 Pain Management Audio

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Chapter 12 Pain Management

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Chapter 12:

Pain Management Pamela Dennis RNC-OB MSN Chapter 12

Pain During Labor and Birth :

Pain During Labor and Birth Perception of pain Threshold remarkably similar in all, regardless of gender, social, ethnic, or cultural differences Differences play definite role in person’s perception of and behavioral responses to pain

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Fig. 16-1. Discomfort during labor. A, Distribution of labor pain during first stage. B, Distribution of labor pain during later phase of first stage and early phase of second stage. C, Distribution of labor pain during later phase of second stage and during birth. ( Gray shading indicates areas of mild discomfort; light-colored shading indicates areas of moderate discomfort; dark-colored shading indicates areas of intense discomfort.)

Non-pharmacologic Management of Pain:

Non-pharmacologic Management of Pain Nonpharmacologic measures often simple, safe, and inexpensive Provide sense of control over childbirth and measures best for woman Methods require practice for best results Try variety of methods and seek alternatives, including pharmacologic methods, if measure used is not effective

Non-pharmacologic Management of Pain :

Non-pharmacologic Management of Pain Childbirth preparation methods Dick-Read method Lamaze method Bradley method HypnoBirthing Birthing from within Childbirth and Postpartum Professional Association

Non-pharmacologic Management of Pain :

Non-pharmacologic Management of Pain Relaxing and breathing techniques Relaxation Imagery and visualization Music Touch and massage Conscious breathing Energy work Effleurage and counterpressure Water therapy (hydrotherapy)

Non-pharmacologic Management of Pain:

Non-pharmacologic Management of Pain Relaxing and breathing techniques Transcutaneous electrical nerve stimulation Acupressure and acupuncture Applications of heat and cold Hypnosis Biofeedback Aromatherapy Intradermal water block

PowerPoint Presentation:

Fig. 16-7. Intradermal injections of 0.1 ml of sterile water in the treatment of women with back pain during labor. Sterile water is injected into four locations on the lower back, two over each posterior superior iliac spine (PSIS) and two 3 cm below and 1 cm medial to the PSIS. The injections should raise a bleb on the skin. Simultaneous injections administered by two clinicians decreases the pain of the injections.

Pharmacologic Management of Discomfort :

Pharmacologic Management of Discomfort Sedatives (Barbiturates) Analgesia and anesthesia Local Anesthesia Regional Anesthesia Systemic analgesia Opioid (narcotic) agonist analgesics Opioid (narcotic) agonist–antagonist analgesics Opioid (narcotic) antagonists

Pharmacologic Management of Discomfort:

Pharmacologic Management of Discomfort Nerve block analgesia and anesthesia Local perineal infiltration anesthesia Pudendal nerve block Spinal anesthesia (block) Disadvantages Marked hypotension Impaired placental perfusion Ineffective breathing patterns Headache Autologous epidural blood patch

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Fig. 16-8. Pain pathways and sites of pharmacologic nerve blocks. A, Pudendal block; suitable during second and third stages of labor and for repair of episiotomy. B, Epidural block; suitable during all stages of labor and for repair of episiotomy.

PowerPoint Presentation:

Fig. 16-9. Pudendal block. Use of needle guide (“Iowa trumpet”) and Luer-Lok syringe to inject medication.

Pharmacologic Management of Pain:

Pharmacologic Management of Pain Nerve block analgesia and anesthesia Epidural anesthesia/analgesia Lumbar epidural anesthesia/analgesia Caudal epidural block Walking epidural analgesia Epidural and intrathecal opioids

Pharmacologic Management of Pain :

Pharmacologic Management of Pain Nerve block analgesia and anesthesia Epidural anesthesia/analgesia Contraindications to epidural blocks Maternal refusal or inability to cooperate Maternal cardiac conditions Antepartum hemorrhage Anticoagulant therapy or bleeding disorder Infection at injection site Allergy to anesthetic drug

Pharmacologic Management of Pain:

Pharmacologic Management of Pain Nerve block analgesia and anesthesia Epidural anesthesia/analgesia Effects of epidural block on neonate Paracervical (uterosacral) nerve block Nitrous oxide for analgesia

PowerPoint Presentation:

Fig. 16-10. A, Membranes and spaces of spinal cord and levels of sacral, lumbar, and thoracic nerves. B, Cross section of vertebra and spinal cord.

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Fig. 16-10. C, Levels of anesthesia necessary for cesarean and vaginal births.

Pharmacologic Management of Pain :

Pharmacologic Management of Pain General anesthesia Used rarely for vaginal births Infrequently for elective cesarean section May be necessary if indications necessitate a rapid birth

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Fig. 16-13. Technique of applying pressure on cricoid cartilage to occlude esophagus to prevent pulmonary aspiration of gastric contents during induction of general anesthesia.

Nursing Care Management :

Nursing Care Management Plan of care and implementation Nonpharmacologic interventions Informed consent Timing of administration Preparation for procedures

Nursing Care Management :

Nursing Care Management Plan of care and implementation Administration of medication Intravenous route Intramuscular route Spinal nerve block Signs of potential problems Safety and general care Anesthesia in obese woman

Nursing Care Management :

Nursing Care Management Plan of care and implementation Maternal hypothermia after analgesia and anesthesia Defined as core body temperature of less than 35° C Caused by effects of analgesia and anesthesia May result in cardiovascular, pulmonary, circulatory, hematologic, neurologic, or renal complications