III.
ANALGESIA AND ANESTHESIA
OBJECTIVES
At the end of this lecture, the student will be able to:
1. Describe the origin of discomfort during the various phases and stages of labor.
2. Explain how excessive pain can affect the laboring and the fetus.
3. Describe how various physiological and psychosocial factors can affect the pain
experience.
4. Compare and contrast pharmacological and nonpharmacological methods of pain
relief.
5. Describe how medication can affect a pregnant woman and the fetus or neonate.
6. List nursing interventions related to various methods of intrapartum pain
management.
OUTLINE
I. Labor Pain
A. Data Collection and Assessment
B. First Stage
C. Second Stage
D. Third Stage
II. Adverse Effects of Excessive Pain
A. Physiological effects
B. Psychological effects
III. Factors Influencing Perception of Discomfort
IV. Pertinent Nursing Diagnoses
V. Nursing Care Planning
A. Non-Pharmacological Pain Interventions
B. Preparation for Pain Management
VI. Pharmacological Pain Management
A. Considerations for the Pregnant Patient
B. Analgesics and Adjuncts
C. Anesthetics
D. Regional Anesthetics
E. General Anesthesia
VII. Evaluation
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CRITICAL THINKING SCENARIOS
1. Your assigned patient has received an opoid epidural medication for her cesarean
birth. Describe the nursing responsibilities in the first 24 hours post delivery.
2. The patient in LDRP room number 2 is experiencing the transition phase of stage I
of labor. She is requesting some pain medication. How would you proceed in this situation?
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Pain Medications for Labor and Delivery (Updated 3/26/02)
MEDICATION
Sedative: Morphine
Analgesic: Fentanyl
Epidural: Fentanyl;
Marcaine; Lidocaine
TIME GIVEN
BENEFITS
Very early labor (evening 
or night)
Active labor;


Lasts 1 to 2 hours

Active labor;

Usually at 3+ cm,
depending on situation
Epidural
Lasts 1 to 2 hours
Cesarean delivery;

Lasts 1 to 2 hours


Spinal Block
Cesarean delivery;

Lasts 1 to 2 hours


General Anesthesia
Cesarean delivery;


Sleep or rest
SIDE EFFECTS

Takes the edge off

Enhances relaxation

Reduces perception of o
contraction
Decreases pain

sensation








Numbs body from
breast down to toes
Mother awake and
aware
Requires higher doses
of medication
Numbs body from

breast down to toes
Mother awake and

aware
Requires less
medication
Asleep

Pain-free state
Administered by gas and
IV medications
Post Partum:
Percocet; Vicodin; Motrin
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May depress baby if given too close to
time of delivery
Possible drowsiness
Mild lethargy in baby if given too close t
time of delivery
May lower maternal blood pressure
May slow progress of labor
IV and continuous fetal heart rate and
maternal blood pressure monitoring
Confined to bed
Will get Foley catheter
May feel pulling or pressure, but no pain
May lower blood pressure temporarily
Nausea
Possible spinal headache after delivery
Baby will be delivered within 5 to 10
minutes with little or no effect on baby
Possible spinal headache after delivery
Baby will be delivered within 4 to 7
minutes to minimize effects of anesthesi
a
on baby
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99
100
IV.
NURSING IN THE NORMAL PUERPERIUM
OBJECTIVES:
At the completion of this class, the student will be able to:
1. Explain the physiological changes that occur during the postpartum period.
2. Identify priority nursing assessment for the postpartum patient.
3. Describe the nursing responsibilities regarding teaching the patient and
family during the postpartum period.
4. Apply the nursing process to the care of the postpartum woman and family.
5. List criteria for early discharge following a birth.
6. Compare the nursing assessment, interventions, and diagnosis for a woman
who delivers vaginally with those experiencing surgical births.
7. Describe the physiology of lactation.
8. Identify nursing assessments, diagnoses and interventions for women
experiencing common problems while breastfeeding.
9. Identify nursing assessments, diagnoses and interventions for women and
neonates receiving formula feeding.
10. Compare and contrast various contraceptive methods in terms of safety,
effectiveness, convenience, availability, expense, and patient preference.
11. Develop strategies for promoting family learning during the early postpartum period.
12. Discuss appropriate nursing interventions to promote maternal comfort and well-being.
OUTLINE
I.
Physiology of the puerperium
A. Alterations in body systems as a result of the birth process
1. Reproductive system
a. Involution
b. Ovulation
2. Gastrointestinal system
3. Renal system
4. Cardiovascular system
5. Psychosocial changes
II.
Nursing Process
A. Data collection
B. Assessment – Physiologic and psychosocial
C. Nursing Diagnoses
D. Interventions/Rationales
E. Evaluation
III.
Contraception Education (video)
A. Considerations for Choosing a Method
1. Action
2. Safety
3. Effectiveness
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Convenience
Availability
Expense
Patient preference
B. Considerations of various methods
1. Barrier
2. Hormonal methods
3. Intrauterine devices
4. Natural family planning methods
5. Sterilization
6. Other
Care of the Lactating Woman
A. Physiology of lactation
B. Hormonal changes at birth
C. Supply/Demand
D. Positioning (Skills lab)
E. Common breastfeeding concerns (Skills Lab)
F. Nutritional requirements
Care of the cesarean birth patient
A. Assessment
B. Nursing diagnoses
C. Interventions/Rationales
4.
5.
6.
7.
IV.
V.
VI.
Preparation for discharge
A. Self-care
B. Signs and symptoms of complications
CRITICAL THINKING EXERCISES FOR POSTPARTUM
1. As you assess your patient and inquire about the breastfeeding, she tells you that
she is considering discontinuing breastfeeding because she “doesn’t have enough
milk.” Indicate what other information you need in order to intervene in this
situation. How would you respond to this statement?
2. Your patient, a newly delivered primipara 22 year old, is crying in her room. Her
midwife has just informed her that she meets the criteria for early discharge and
will be discharged later in the day. How would you intervene in this situation?
3. Your assigned patient is a recent immigrant from Mexico. She does not speak any
English. Her baby is in the level II nursery with jaundice and under
phototherapy. Your patient has no immediate family in the country and no other
support systems. Describe how you would proceed to provide optimal care for
this patient?
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LATCH SCORING TABLE
0
1
2
L
LATCH
Too sleepy or reluctant Repeated attempts
Must hold nipple in
No latch obtained
mouth
Must stimulate to
suck
Grasps breast
Tongue down and
forward
Lips flanged
Rhythmic suckling
A
AUDIBLE
SWALLOWING
None
Spontaneous,
intermittent
(less than 24 hours
old)
Spontaneous,
frequent
(greater than 24
hours old)
T
TYPE OF
NIPPLE
COMFORT
Inverted
C
H
A few with
stimulation
Flat
Everted (after
stimulation)
(Breast/Nipple)
Engorged
Cracked, bleeding,
large blisters or bruises
Severe discomfort
Filling, Small blisters
or bruises
Mother complains of
pinching
Mild/moderate
discomfort
HOLD
Full assist (staff holds
infant at breast)
Minimal assist (i.e.
No assist from staff.
elevate head of bed,
Mother able to
place pillows)
Teach one side,
position/hold infant.
mother does other.
Staff help, mother takes
over feeding.
(Positioning)
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Soft
Tender
Intact nipples (no
damage)
104
105
106
107
108