pain and pain management
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- Created by: Ruby waterhouse
- Created on: 16-11-20 20:56
what is pain?
a complex, personal, manufactural phenomenon that is influenced by, physiological and sociocultural factors
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what is pain known as?
what are these activated by?
what are these activated by?
nociceptors
-activated by noxious stimuli
-activated by noxious stimuli
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what is the noxious stimuli?
- tissue damaging event
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how is pain processed by the brain?
- signals from nociceptors passed down the autonomic nervous system, through the spinal cord to the brain
- neurons in the cortex then process the sensation of pain
- neurons in the cortex then process the sensation of pain
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when is pain heightened ?
- in the presence of fear and anxiety
- effected by expectation, level of attention and emotional belief
- effected by expectation, level of attention and emotional belief
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what are unmyelinated C nerve fibres?
- dominates pain in the first stage of labour
- found in the deep viscera (organs) such as the uterus
- give rise to prolonged sensation of contractions due to muscle alterations
- found in the deep viscera (organs) such as the uterus
- give rise to prolonged sensation of contractions due to muscle alterations
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what are thinly myelinated alpha- delta nerve fibres ?
what are they assonated with?
what are they simulated by?
what are they assonated with?
what are they simulated by?
-these are associated with the second stage of labour
- simulated by the sharp pain felt in the vagina and perineum
- simulated by the sharp pain felt in the vagina and perineum
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visceral pain
what does this relate to?
why does it occur?
what does this relate to?
why does it occur?
- pain which originates in deeply situated organs such as the uterus during birth
- occurs due to the contraction of the uterine muscle which simulates mechanoreceptors and nociceptors
- occurs due to the contraction of the uterine muscle which simulates mechanoreceptors and nociceptors
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somatic pain
what does this relate to?
why does it occur?
what does this relate to?
why does it occur?
- pain that is from the skin or muscles eg stretching of the perineal skin or tearing
- occurs due to the distension of the pelvic floor, perineum and vagina
- occurs due to the distension of the pelvic floor, perineum and vagina
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pain management options alternative to medication
- water - pool, bath or shower
- hypnobirthing
- aromatherapy
- tens machine
- massage
- movement
- hypnobirthing
- aromatherapy
- tens machine
- massage
- movement
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pharmaceutical pain management options
- simple analgesia
- Entonox
- pethidine/ diamorphine
- epidural
- Entonox
- pethidine/ diamorphine
- epidural
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benefits of labouring in water
- increased oxygenation and blood supply to uterine muscles (making contractions more effective)
- increased oxygenated of baby
- lower rates of reported pain
- reduction of blood pressure and anxiety
- increased oxygenated of baby
- lower rates of reported pain
- reduction of blood pressure and anxiety
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water temperature in birth pool
first stage of labour
second stage of labour
first stage of labour
second stage of labour
- 33.37 degrees for first stage of labour
- 37.5 degrees in second stage of labour
- 37.5 degrees in second stage of labour
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pros and cons of hypnobirthing
can help manage stress hormones and supports the production of oxytocin
- can shorten labour for some women
- can help partners feel more involved with labour
-reduce the need for further pain relief
- no known side effects for mum or baby
- limited re
- can shorten labour for some women
- can help partners feel more involved with labour
-reduce the need for further pain relief
- no known side effects for mum or baby
- limited re
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aromatherapy and massage
how is it used ?
who is it usually used on?
what is it important for midwives to do when thinking about aromatherapy ?
how is it used ?
who is it usually used on?
what is it important for midwives to do when thinking about aromatherapy ?
- often only advised to be used in "universal care"/ women at low risk
- uses the healing power of plants and essential oils to support relaxation and pain relief and to induce labour
- important that midwives have knowledge of the effectiveness of the ar
- uses the healing power of plants and essential oils to support relaxation and pain relief and to induce labour
- important that midwives have knowledge of the effectiveness of the ar
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tens machine (transcutaneous electrical nerve simulation)
what is this?
how does it work?
what stage of labour is this not to be used in?
what is this?
how does it work?
what stage of labour is this not to be used in?
- battery operated device that has 4 electrodes that are applied to the skin
- works by intercepting pain signals which are transmitted thorugh the spinal cord and encourages the body to release endorphins (natural pain killer)
- not to be used in active
- works by intercepting pain signals which are transmitted thorugh the spinal cord and encourages the body to release endorphins (natural pain killer)
- not to be used in active
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different types of simple analgesia (pain relief)
- paracetamol/ co-drydamol
when is this used ?
what should midwives be aware of when prescribing paracetamol in Pregnancy
- paracetamol/ co-drydamol
when is this used ?
what should midwives be aware of when prescribing paracetamol in Pregnancy
- regularly used as a first line pain relief in labour
- be aware of over use of paracetamol - increases likelihood of childhood asthma, rduced testosterone in boys, ADHD.
- be aware of over use of paracetamol - increases likelihood of childhood asthma, rduced testosterone in boys, ADHD.
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entanox
what is it made up of?
when is it effective??
when should it not be given?
what is it made up of?
when is it effective??
when should it not be given?
-50% nitrous oxide and 50% oxygen
- effective within 20 seconds of administration
- should not be given to women with pernicious anaemia - important to be mindful of staff with this condition as well
- effective within 20 seconds of administration
- should not be given to women with pernicious anaemia - important to be mindful of staff with this condition as well
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Diamorphine
how is this given?
what is it mixed with and how often?
what is the dosage ?
side effects
how is this given?
what is it mixed with and how often?
what is the dosage ?
side effects
- give via instamuscular injection in the upper thigh
- mixed with antiemetic (every 6 hours)
- 5-10mg every 4 hours as required (BMI dependent)
- side effects - anorexia, rasied intracranial pressure, suspected prolonged labour
- mixed with antiemetic (every 6 hours)
- 5-10mg every 4 hours as required (BMI dependent)
- side effects - anorexia, rasied intracranial pressure, suspected prolonged labour
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diamorphine and pethidine
how is it given?
what is it mixed with and how often?
side effects
what stage of labour is this prescribed?
how is it given?
what is it mixed with and how often?
side effects
what stage of labour is this prescribed?
- given via intramuscular injection in upper thigh
- mixed with antiemetic (every 6 hours)
side effects- nausea, hypothermia, neonatal respiratory distress
- can be prescribed by midwives in active labour
- mixed with antiemetic (every 6 hours)
side effects- nausea, hypothermia, neonatal respiratory distress
- can be prescribed by midwives in active labour
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remifentanil
where must this be given?
who can it not be given to?
side effects
where must this be given?
who can it not be given to?
side effects
- must be given on obstetric birth suites
- can not be given to women who have received diamorphine or pethidine in the previous 4 hours
- continous monitoring is essential
- side effects - nausea, itching, drowsiness, slow breathing, slow heart rate.
- can not be given to women who have received diamorphine or pethidine in the previous 4 hours
- continous monitoring is essential
- side effects - nausea, itching, drowsiness, slow breathing, slow heart rate.
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epidural
potential side effects associated with this
potential side effects associated with this
- low blood pressure
- itchy skin
- headaches
- increased risk of prolonged labour
- increased risk of instrumental birth
- itchy skin
- headaches
- increased risk of prolonged labour
- increased risk of instrumental birth
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benefits of continuity of carer
- strong evidence to suggest that continuity of carer can reduce need for pharmaceutical analgesia.
- significantly improves better birth experience and satisfaction
- 60% didn't use analgesia when they were cared for by Albany midwives
- significantly improves better birth experience and satisfaction
- 60% didn't use analgesia when they were cared for by Albany midwives
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how to help the woman work with pain
- antenatal education
- informed decision making
- birth as a physiological process
- women can cope with physiological birth
- long term benefits to avoiding side effects of pharmaceutical analgesia
(cascade of intervention)
- informed decision making
- birth as a physiological process
- women can cope with physiological birth
- long term benefits to avoiding side effects of pharmaceutical analgesia
(cascade of intervention)
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why do we take pain away?
- informed choice
- a desire to be kind - don't want to see the woman in pain
- staff shortages - easier to give pain relief
-
- a desire to be kind - don't want to see the woman in pain
- staff shortages - easier to give pain relief
-
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medicines management
what does OD,BD,TDS,QDS,PRN mean?
what does OD,BD,TDS,QDS,PRN mean?
-1 a day
-2 a day
-3 a day
- 4 a day
PRN - when needed
-2 a day
-3 a day
- 4 a day
PRN - when needed
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you need to give 10mg of diamorphine, you only have 5mg ampules, how many do you give?
2x 5mg
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what are they key things to check before giving medication?
- allergies
- name
- date
- DOB of patient
- correct medication
- dosage
- use by date
- name
- date
- DOB of patient
- correct medication
- dosage
- use by date
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a
woman you are caring for is requesting pethidine every 4 hours
should this be mixed with an anti - emetic?
and how often should this then be given?
woman you are caring for is requesting pethidine every 4 hours
should this be mixed with an anti - emetic?
and how often should this then be given?
- yes every 6 hours
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a woman is prescribed 1l of plasmalyte solution over 4 hours how much fluid should she receive every hour ?
250ml
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how many milligrams is in 1g ?
how many milligrams in 1mg?
how many milligrams in 1mg?
1000
1000
1000
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Other cards in this set
Card 2
Front
what is pain known as?
what are these activated by?
what are these activated by?
Back
nociceptors
-activated by noxious stimuli
-activated by noxious stimuli
Card 3
Front
what is the noxious stimuli?
Back
Card 4
Front
how is pain processed by the brain?
Back
Card 5
Front
when is pain heightened ?
Back
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