Obstetric Patient Pain Management and Care
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NUR 209 M6A3: Obstetric Patient Pain Management and Care Paper rubic
APA format ,write a six (6) to ten (10) page paper exclude cover and references page that addresses the comfort and pain relief need of the antepartum intrapartum and postpartum patient
A minimum of three (3) current professional references must be provided. Current references include professional publication or valid and current website dated within five (5) years. Additional, a textbook that is no more than one (1) edition old may be used
the paper consists of (2)parts
Use a 12 font size double space APA format for citations ,references and overall format
Avoid plagiarism. Paper one : look at the cause and management interventions of discomfort and pain during pregnancy, labor birth and recovery from birth .Part two (2) is a component of a teaching plan the register nurse would use to assist an antenatal patient make an informed decision regarding pain relief measures to be used during labor and birth.
Part A : Identify and explain (2) sources of the antepartum patient ,intrapartum patient and postpartum patient during an uncomplicated pregnancy ,labor and recovery from the birthing process’s Part B : Identify one (1) pharmacological and two (2) non pharmacologic pain management measures for the intrapartum patient. Explain the benefits and risk of these pain management measures
one more part thanks for your patience.
Part 2 In order for the woman to make an inform decision regarding pain relief measures to be used in the intrapartum period ,the information needs to be provided in the antepartum period. Before finalizing a teaching plan for the pregnant woman ,her history needs to be assessed to determine any variables that may affect content of teaching plan .For example ,are there any language /barriers that will affect care provided during labor and birth.Before finalizing a teaching plan for the pregnant woman ,her history needs to be assessed to determine any variables that may affect you the content of the teaching plan .For example ,are there any language variables /barriers that will affect care provided during labor and birth.? A . Identify three (3) variables unique to the pregnant patient that need to be considered when developing a specific pain management teaching plan for the antepartal patient preparing for labor and birth. Provide an explanation why each of these three (3) variables preparing for labor and birth. Provide an explanation why each of these three (3) variables need to be considered when developing a teaching plan for an obstetric patient . B. Select two (2) non -pharmacologic pain relief options used in the intrapartum period . For each option, explain three (3) specific points information related to this pain relief option that need to be taught to the patient . Include rationales for each piece of content regarding why you would need to incorporate this information.
For part A is identify and explain 2 sources of pain for the antepartum patient intrapartum ad postpartum patient during an uncomplicated pregnancy labor ,and recovery from birthing process. . I miss out pain on top
include I part 2 A provide an Explanation why each of these three (3) variables need to be considered when developing a teaching plan an obstetric patient . I repeated it 2 above .
SAMPLE ANSWER
Obstetric Patient Pain Management and Care
PART 1
Pain would occur in pregnancy and delivery regardless of whether there are complications or not. It is possible to categorize such pain on the basis of the stages where patients experience it. Pains could occur at the ante-natal, intra-natal, and also at post-natal stages. Sources of pain vary from those that are expected; not necessarily in disease, to those resulting from complications. Also, pains could be specific to pregnancy and delivery or non-specific to the processes. Examples of pains that could occur in various stages of pregnancy and delivery include a headache and backaches. Nerve entrapment, abdominal stretching, and trauma are potential sources of pain in pregnancies and non-complicated deliveries.
Abdominal stretching is usually intense as from the third trimester of pregnancy (National Partnership for Women and Families, 2010). The uterus stretches in such a way that it accommodates the enlarging fetus, and in the process, it occupies most of the abdominal cavity. At late antenatal stages, the uterus would have extended to levels just slightly below the sternum, and its positioning would be pressurizing the fundus (National Partnership for Women and Families, 2010). The stretching also has a substantial impact on ligaments. The structures have to bear the weight of the fetus, and their pulling could result in back pains (March of Dimes Foundation, 2013). Round ligament pains and Braxton-Hicks contractions happen following the straining of the ligaments (McDermott, 2015). Usually, the pains begin at the ante-natal stage, continues throughout labor and still retain effects at the post-natal stage. Such pains constitute most of the experiences of labor in women (National Partnership for Women and Families, 2010). Abdominal stretching also has an effect on pelvic expansion. At the antenatal stage, the pelvic is constantly expanding in preparation for childbirth. The stretching is also a source of pain during delivery and accounts for a significant portion of labor pains. Abdominal stretching also causes difficulties in processes such as breathing and urination. An expanded uterus pressurizes both the diaphragm and the bladder, and the situation results in the impairment of breathing and urination. Also, the stretching of the vagina and the cervix could cause significant swelling and pains on the perineum (National Partnership for Women and Families, 2010). Under normal circumstances, stretching fades away through the post-partum stage and women would only experience mild discomfort as structures regain their normal sizes. At the post-partum stage, pain and discomfort are mainly from mild spasm that characterize the process of regaining normalcy. Uterine prolapse, rectocele, and cystocele are sources of pains in the post-natal stage, and they bear link with earlier abdominal stretching (Romano, Cacciatore, Giordano, & Rosa, 2010, Pg. 22).
Nerve injury could also result in pain in pregnancies and deliveries that are non-complicated. Nerves that are likely to bear injury include the femoral, sciatic, lateral femoral cutaneous, obturator and the lumbosacral plexus. Such injuries could result from compression, traction, transection, as well as vascular injury. Most of the injuries would occur at childbirth following events such as prolonged abduction and hyperflexion of the hips. Physical injuries that hurt such nerves during antenatal and post-natal stages would also cause pain.
Pharmacological and Non-Pharmacological Approaches of Managing Intrapartum Pain
Pethidine is a strong and fast acting analgesic drug that could be useful in the relieve of intrapartum pain. It is an opioid and it works by mimicking endorphins. Endorphins stimulate their receptors to mediate pain, and their substitution with opioid drugs limit pain mediation. Opioid receptors occur in the brain and the spinal cord, and opioids interact with them to block the transmission of pain signals. However, the drug only alleviates the sensation of pain, but it does not eliminate the causal factor for such pain. Pethidine is beneficial in that it achieves effects within a short period not exceeding twenty minutes. It is also possible to take the drug through a variety of routes, hence making it applicable to a broad range of patients. Common routes of pethidine administration include intramuscular and subcutaneous injections, as well as an oral intake as tablets. The drug is also advantageous in that patients can take it either with food or without. Disadvantages of pethidine include its inducement of drowsiness in patients. Also, the drug is contraindicated in patients with constipation, yet the condition is common among obstetric patients.
Non-pharmacological interventions for the management of intrapartum pain include positive conditioning of the clinical environment and acupuncture. The former method involves minimization of distractions and creating a peaceful environment for relaxation. The method is cheap, easy to administer, and it applies to most types of obstetric patients. However, it has a low degree of efficiency, especially in comparison with the pharmacological techniques. As such, it would be risky to depend on the method alone for pain management. Acupuncture is beneficial in that it causes relaxation in patients and gives them a soothing sensation that minimizes the effect of labor pains. Unlike most of other procedures, acupuncture offers a desirable sensation that patients may yearn to experience. However, acupuncture is associated with risks such as loss of consciousness and the possibility of the emergence of sores at the site of administration (NHS Choices, 2015). The method also creates substantial predisposition of the acquisition of infections. Besides, organ injury may occur, and only qualified personnel should apply it.
PART 2
Considering particular factors that apply to patients before educating them is a move to offer high-quality obstetric care. Different pain management techniques used in obstetric care vary in the effect they have on patients. Some would be appropriate for a particular type of patients but inappropriate for others. Patients are likely to benefit from educations that address their concerns to satisfaction. As such, educators should convert their broad range of information into forms that are most helpful to their clients.
Patient history and examinations should be the focus of obstetric care educators. Some patients could present with occurrences that are not normal, especially regarding the use of medications. Before advocating for a particular anesthetic pharmacological methods of pain management, educators should evaluate their patients to establish the appropriate of such medications. The educators should use patient history to either approve or disapprove the necessity of using anesthetic drugs. For example, anesthetic drugs could cause adversities in patients with obesity, diabetes, preeclampsia, HELLP syndrome, and hypertensive disorders associated with pregnancy. Important health conditions for educators to consider in their patients include the status of the lungs, heart, and airway. Such history would be vital in determining the form of obstetric care that clinicians would offer to their clients.
Educators should also assess the needs of their patients and consider them against the available resources. For instance, some women may have medical conditions that would suggest an indispensable need for analgesic or anesthetic interventions. Educators should purpose to offer recommendations to patients who are in need of them. Some healthy women may not need pain relieving medications, and educators would focus on other areas of care provision rather than exploring the drugs. Also, educators should learn the financial ability that their patients have so as to determine how accessible quality care is to them. For patients who may not meet the financial costs of standard care, educators would offer advice on insurance policies that the patient would consider in overcoming the challenge.
It would also be important for patient educators to consider the obstetric history of their patients. For instance, women who would have had complications in their previous deliveries might require anesthetic medications depending on the nature of their difficulties. Also, close monitoring of patients who have never given birth would be necessary. The educators would familiarize such patients on the issues to expect. For instance, they could inform them on the nature of pain and the best strategies for minimizing it. Giving such information would allow the patients to make necessary arrangements such as financial and behavioral preparations.
TENS (Transcutaneous electrical nerve stimulation) is among common non-pharmacological methods that are used in managing pain in obstetric patients at the intrapartum level. The method involves the placement of four soft pads on the back of the patient and then running a gentle electric current to induce a massaging effect to the patient (Johnson, Paley, Howe, & Sluka, 2015).
It would be necessary for the patient to know the mechanism by which the method works. Informed patients are likely to cooperate and facilitate the use of the technique for pain relief. TENS work by creating a tingling sensation that stimulates the body to produce endogenous endorphins (Guy’s and St, Thomas’ NHS Foundation Trust, n.d., Pg. 4). Patients are likely to accept methods if they understand them fully.
Also, it would be important for the patient to know the benefits of using TENS in pain management. Such benefits include the handiness of the tool whereby one can control it effectively. Also, the method has no side effects to the newborn, making it a safe approach. Patients would rely on the benefits for them to consider exploiting the method.
The patient should also learn the shortcomings of the method. TENS is limited in that its effect is reduced if it is not started early enough. Also, there is a possibility of patients showing allergic reactions to the electrolytes used in TENS. Informing the patient on the disadvantages of the method would allow them make informed decisions.
The positions that patients assume when giving birth is also a non-pharmacological approach to managing intrapartum pains. Clients should understand the positions that would lead to minimal injury. The understanding would help them avoid unnecessary injuries.
The clients need understanding the benefits of applying the technique in managing pain. The benefits include shortened labor periods and its concurrent applicability of other methods. Knowing the advantages would enable patients determine whether they would need applying the technique.
Also, the patients should understand the shortcomings of the technique. For instance, none of the positions would alleviate pain completely. Again, the patient would require support from other persons for the method to work. Understanding the shortcomings would allow patients make informed choices.
References
Guy’s and St, Thomas’ NHS Foundation Trust. (n.d). Coping methods and options for pain relief in labour. Retrieved from http://www.guysandstthomas.nhs.uk/resources/patient-information/maternity/coping-methods-and-pain-relief-in-labour.pdf
Johnson, M. I., Paley, C. A., Howe, T. E. & Sluka, K. A. (2015). Transcutaneous Electrical Nerve Stimulation (TENS) to treat acute pain in adults. THE Cochrane Collaboration. Retrieved from http://www.cochrane.org/CD006142/SYMPT_transcutaneous-electrical-nerve-stimulation-tens-to-treat-acute-pain-in-adults
March of Dimes Foundation. (2013). Abdominal pain or cramping? Retrieved from http://www.marchofdimes.org/pregnancy/print/abdominal-pain-or-cramping.html
McDermott, A. (2015, June 18). Abdominal Pain During Pregnancy: Is It Gas Pain or Something Else? Healthline. Retrieved from http://www.healthline.com/health/pregnancy/gas-pain-during-pregnancy
National Partnership for Women and Families. (2010). Journey to Parenthood: your body in the third trimester of pregnancy National Partnership for women and families. Retrieved from http://www.childbirthconnection.org/article.asp?ck=10507
NHS Choices. (2015). Acupuncture has hidden dangers. Retrieved from http://www.nhs.uk/news/2012/09September/Pages/Acupuncture-has-hidden-dangers.aspx
Romano, M., Cacciatore, A., Giordano, R., & La Rosa, B. (2010). Postpartum period: three distinct but continuous phases. Journal of Prenatal Medicine, 4(2), 22–25.
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