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MANAJEMEN NYERI SELAMA PERSALINAN Ns.Wahyu ikka Setyarini, Mkep,Sp Mat NS. Lutfatul Latifah, Mkep,Sp.Mat

MANAJEMEN NYERI SELAMA PERSALINAN Ns.Wahyu ikka Setyarini, Mkep,Sp Mat NS. Lutfatul Latifah, Mkep,Sp.Mat. Definisi nyeri. Pengalaman pribadi,subyektifitas, berbeda antara satu orang dengan orang lain dan dapat juga berbeda pada orang yang sama di waktu berbeda

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MANAJEMEN NYERI SELAMA PERSALINAN Ns.Wahyu ikka Setyarini, Mkep,Sp Mat NS. Lutfatul Latifah, Mkep,Sp.Mat

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  1. MANAJEMEN NYERI SELAMA PERSALINAN Ns.Wahyu ikka Setyarini, Mkep,Sp Mat NS. Lutfatul Latifah, Mkep,Sp.Mat

  2. Definisi nyeri • Pengalaman pribadi,subyektifitas, berbeda antara satu orang dengan orang lain dan dapat juga berbeda pada orang yang sama di waktu berbeda • Pain in childbirth is a universal experience and considered a normaloccurrence • Pain associated with labor has been described as one ofthe most intensely painful experiences possible

  3. Faktor-Faktor yang mempengaruhiNyeriPersalinanKecemasandanketakutanRiwayat trauma persalinanKulturdannilaisosialTingkat pengetahuandanpendidikanLingkunganSupportsosialPengalaman (antisipasi, keberadaan & akibat setelah nyeri

  4. MANAJEMEN NYERI SELAMA PERSALINAN • Breating and relaxation techniques. • Comfort measure • Management nyeri non farmakologi

  5. Keunikan nyeri selama proses persalinanKecemasan dapat berkurang jika seseorang mengetahui kapan waktu nyeri dan berapa lama nyeri berlangsungAda produk akhir yg dihasilkan dari nyeri yg berlangsung

  6. LABOR PAIN VERSUS OTHERKINDS OF PAIN

  7. Source of Labor Pain • Nyeri ditransmisikan dr perifer mlalui jalur syaraf ke otak • Penyebab nyeri : • Uterine contractions resulting in uterine pain from a decrease inblood supply to the uterus • Peningkatan tekanan dan peregangan struktur panggul mengakibatkan ligamen, otot, dan peritoneum tertarik & meluas • Cervical dilation and stretching resulting in the stimulation of the nerve ganglia

  8. Intensity and distribution of labor discomfortduringvarious stages of labor: A. First stage; B. Early secondstage; C. Late second stage and birth Red : severe Blue : moderate Yellow : mild

  9. Pain Pathways T 10,11, 12 L1 S2, 3, 4

  10. Panduan mengkaji nyeri pasien • Kontraksi (freukensi,durasi,intensitas) • Sikap klien tehadap kontraksi • Kemajuan persalinan • Significant other • Kondisi kesehatan fisik dan psikologis pasien • Kebutuhan terhadap methoda pereda nyeri

  11. Nonpharmacological Management of Labor Discomfort • Preparation by the woman for childbirth • Cutaneous stimulation • Thermalstimulation • Mental stimulation • The presence of a support person

  12. Childbirth preparation methods • Dick-Read method: Advocates birth without fear by educationand environmental control and relaxation. • Lamaze: Promotes psychoprophylaxis with conditioning and breathing. • Bradley: A husband-coached childbirth and support byworking with and managing the pain rather than being distracted away from it. • Relaxation and breathing techniques: Varied breathing patternsthat promote relaxation and avoidance of pushing before complete cervical dilation.

  13. Cutaneous stimulation • Effleurage, massageby self, is done by lightly stroking the abdomen inrhythm with breathing during contractions • Backmassage and/or counterpressureto the sacral area by another. • Counterpressureis exerted tothe sacral area with the heel of the hand or fist to relievethe sensation of intense pain in the back caused by internalpressure of the fetal head. This increased internal pressure bythe fetal head is often associated with the posterior positionof the fetus during labor.

  14. Thermal stimulation • Application of warmth or cold such asuse of warm showers or ice packs. The use of hydrotherapy viawhirlpools, warm baths, or showers is very effective and promotesrelaxation and comfort. This may reduce the woman’sanxiety and promote well-being, causing a reduction in catecholamineproduction, which interferes with uterine contractility. • Application of cold may release musculoskeletal pain andthe numbing effect of cold may decrease the sensation of pain.

  15. Mental stimulation • Focal points • Imagery, and music help thewoman to concentrate on something outside her body. This helpsher to focus away from the pain.With imagery, the woman isencouraged to bring into her mind a picture of a relaxing scene.

  16. Support person • A significant other and/or a doula providesemotional support and physical comfort and aids in a beneficialform of care. Research has shown that support early in laborsignificantly relieves pain, improves outcomes, decreases interventionsand complication rates, and thus enhances overall maternal satisfaction (Simkin & O’Hara, 2002).

  17. Teknik non farmakologiRelaksasi Guide imageryHipnosis (hipnobirthing) Aromatherapy AcupressureCounter pressureHeat/cold therapyWater steril Injection

  18. Acupressure • The 30-minute acupressure or touch on SP6 acupointwas effective for decreasing labor pain and shorteningthelength of delivery time. • SP6 acupressure can be an effective nursing management for women in labor Mi Kyeong Lee, Soon Bok Chang, & Duck-hee Kang. 2004. Effects Of SP6 Acupressure On Labor Pain And Length OfDelivery Time In Women During Labor. The Journal Of Alternative And Complementary Medicine Volume 10, Number 6,Pp. 959–965

  19. Acupressure • the effect of LI4 and BL67 acupressure in lessening labor pain during the active phase of the first stage of labor Ue-Lin Chung, Li-Chiao Hung, Su-Chen Kuo & Chun-Liang Huang. 2004. Effects of LI4 and BL 67 Acupressure on LaborPain and UterineContractions in the First Stage of LaborJournal of Nursing Research Vol. 11, No. 4 Figure 1. LI4 (Large Intestine 4) and BL67 (Bladder 67).

  20. Techniques for Breathing during contractions (contoh) Dilakukansaatterjadikontraksi uterus. Tujuan : membantuibuuntukrelaksdengancaradistraksi. Langkah 1: mulaidengantehnikmembersihkanpernapasan, menghirupnapasdarihidungdanmengeluarkanlewatmulutdengancaracepat. Langkah 2: Slow chest breatingselama 6-9 kali napaspermenit Lanjutkelangkah 1 lagi.

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