Obstetric Nurse Pain Management in Labor Flashcards

The gate control theory of pain, as applied to labor analgesia, explains how non-pharmacological methods reduce pain by:

Answer: Activating large sensory nerve fibers that inhibit pain signal transmission in the dorsal horn

Stimulation of large-diameter A-beta fibers (via touch, heat, vibration, TENS) inhibits transmission of pain signals carried by smaller C and A-delta fibers at the spinal cord's dorsal horn.

A patient at 39 weeks receives IV morphine for labor pain. The nurse should monitor the newborn most closely for:

Answer: Neonatal respiratory depression, especially if delivery occurs within 1–4 hours of administration

Opioids cross the placenta and can suppress fetal and neonatal respiratory drive; the risk is greatest when delivery occurs at peak maternal drug levels, typically 1–4 hours after IV morphine.

A patient develops a severe positional headache 12 hours after receiving a spinal block during labor. This presentation is most consistent with:

Answer: Post-dural puncture headache (PDPH)

PDPH results from cerebrospinal fluid leakage through an accidental dural puncture, causing traction on meningeal structures; the headache worsens in upright positions and improves when lying flat.

Which maternal position during labor is most effective for relieving back pain associated with an occiput posterior fetal position?

Answer: Hands-and-knees (all-fours) position

The hands-and-knees position uses gravity to encourage anterior rotation of the fetal occiput away from the maternal sacrum, reducing sacral pressure and back pain.

A patient develops a temperature of 38.6°C after 8 hours of epidural analgesia with no other signs of infection. The nurse's best understanding of this finding is:

Answer: Epidural-associated fever can occur without infection and requires evaluation with clinical context

Epidural-associated fever (EAF) is a recognized phenomenon, possibly related to inflammatory mediators; it must be distinguished from infectious causes through clinical assessment but does not automatically require epidural removal.

TENS (transcutaneous electrical nerve stimulation) reduces labor pain primarily through which mechanism?

Answer: Stimulating endorphin release and activating gate control mechanisms in the spinal cord

TENS electrodes deliver low-voltage electrical pulses that stimulate endogenous endorphin release and activate inhibitory pathways via gate control theory, reducing the perception of uterine pain.

Which patterned breathing technique taught in childbirth education classes (such as Lamaze) is primarily used to help manage contraction pain during labor?

Answer: Paced rhythmic breathing synchronized with contractions

Paced rhythmic breathing promotes relaxation, provides a focus of concentration during contractions, and may stimulate endorphin release, helping the patient manage pain without pharmacological intervention.