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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 13 Promoting Patient Comfort During Labor and Birth Edited by Catherine Marin, MSN/Ed©, WHCNP, RN
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley 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
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Physical Causes of Pain Labor and Birth
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain Neurology Uterine ischemia Visceral pain—dull and aching Referred pain Somatic pain—sharp, burning, prickling
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley 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
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Factors Affecting Maternal Pain Response Physical Physiological Psychological Anxiety, fear, previous experience Support systems, childbirth preparation Environmental
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain Pathways and Childbirth Multidimensional phenomenon Affective, physiologic, behavioral, sensory, cognitive Neural pathway for pain Gate-control theory
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Benefits of Comfort and Support Pain Perception
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nonpharmacological Pain Relief Measures Maternal position and movement Breathing techniques Music Relaxation techniques Other attention-focusing strategies Guided imagery
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Massage and Touch Effleurage Counterpressure Therapeutic touch Healing touch
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Therapies for Comfort Hydrotherapy, hypnotherapy, aromatherapy Application of heat and cold Biofeedback, TENS, intradermal water block Acupressure/acupuncture
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pharmacological Pain Relief Measures Timing Nonpharmacological and pharmacological measures promote positive experience Informed consent
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pharmacological Measures Sedatives and antiemetics Barbiturates Benzodiazepines H 1 -Receptor antagonists
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Analgesics and Anesthetics Systemic Opiod agonist analgesics Opiod agonist-antagonist analgesics Opiod antagonists
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley 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
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postdural Puncture Headache Leakage of cerebrospinal fluid Intensified in upright position Auditory and visual problems Autologous epidural blood patch Discharge instructions
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Epidural Anesthesia or Analgesia Block Local anesthetic—epidural space Pain relief from contractions Pain relief from birth Opioid and local anesthetic agent
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Lumbar Epidural Advantages Minimal trauma to fetal skull No fetal respiratory depression Complication Maternal hypotension
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Hypotension Prevention Preload IV fluids Requires constant nursing attendance Monitor vital signs
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Disadvantages of Epidural Limited mobility Common side effects Accidental injection into blood vessel Sympathetic blockage Urinary retention, bladder distention
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Nerve Blocks Combined spinal-epidural analgesia Epidural and intrathecal opioids Ongoing nursing assessments essential
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley General Anesthesia Major risks Pre-operative preparation Cricoid pressure Anesthetic gases and medications Recovery room nursing care
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nursing Care Related to Comfort Measures Assessment Ongoing and collaborative Diagnoses Anxiety Ineffective coping Acute pain
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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nursing Care Expected outcomes Plan of care Individualized Modified as needed Collaborative approach
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