NUR 365 - Chapter 14

Gate Control Theory

Gate Control Theory

Theory that states pain sensations travel along sensory nerve pathways to the brain, but only a limited number of sensations, or messages, can travel through these nerve pathways at a time

• Helps through nonpharmacological measures mainly

Narcan

Drug classified as an opioid antagonist

Narcan

Indications include:

• Reverses opioid-induced respiratory depression in woman or newborn

• May be used to reverse pruritis from epidural opioids

Narcan

Education includes:

• THE PAIN WILL EVENTUALLY RETURN

• Delay breastfeeding until the medication is completely out of the mother’s system

Epidural

Side effects include:

• Limited movement

• HYPOTENSION (change position)

• Dizziness

• Sedation

• Weakness of legs

• CNS effects

• Respiratory arrest

Narcotic Analgesic

Side effects include:

• Respiratory depression

• Sedation

• Euphoria

• Nausea

• Vomiting

• Constipation

Pudendal Block

Anesthesia which transverses the sacrosciatic notch just medial to the tip of the ischial spines on each side; for the second and third stages of labor

• Used for the second and third stages of labor and reduces vaginal pain

Spinal Block

Anesthesia which is injected into the subarachnoic space of the spinal column

• Suitable for any stage of labor

Hyperventilation

S/S include:

• Respiratory alkalosis

• Dizziness

• Tingling of fingers

• Numbness around mouth

Hyperventilation

Causes can include:

• Pain

• Anxiety

Hyperventilation

Interventions include:

• Specific breathing patterns

• Breathing into a bag or cupped hands

Counterpressure

Steady pressure applied by a support person to the sacral area with a firm object such as a tennis ball or the heel or fist of a hand

Counterpressure

Indication is:

Helps in lifting the occult off the nerves in the lower back hence providing pain relief

Visceral pain

Caused by sensory receptors in the thoracic cavity; will happen due to cervical changes, distention of lower uterine segment, pressure and traction on adjacent structures, and uterine ischemia

Referred Pain

Originates in the uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs

Somatic pain

Pain described as intense, sharp, burning, and localized; stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions

Childbirth preparation

Includes:

• Birthing classes

• Relaxation techniques teaching

• Breathing techniques teaching

• Self-hypnosis teaching

• Methods of pain relief

• What’s expected of the mother

• Skin preparation measures

Effleurage

Cutaneous measure; light stroking, usually of the abdomen, in rhythm with breathing during contractions; used to distract laboring women and has been found to decrease the sensation of pain

TENS

Transcutaneous electrical nerve stimulation; provides continuous low-intensity electrical impulses or stimuli from a battery-operated device; often changed from low to high during contractions

Hydrotherapy

Includes things like bathing, showering, whirlpool baths, and water immersion

Heat application

Can relieve muscle ischemia and increase blood flow to areas of discomfort

Cold application

Can increase comfort when the mother is feeling warm and can decrease muscle spasms

Imagery

Focusing thoughts on a pleasant scene, a place where one feels relaxed, or an activity one enjoys

Nitrous Oxide

“Laughing gas”; increases endorphin and dopamine levels to diminish pain and anxiety during labor; has a rapid onset

PDPH

Causes include:

• Spinal anesthesia

• Leakage of CSF from the major site of a puncture

PDPH

Treatment includes:

• Administration of oral analgesics and methylxanthines such as caffeine (causes constriction of cerebral blood vessels and may provide symptomatic pain relief)

• Epidural blood patch (most rapid, reliable, and beneficial relief measure)