A patient in labor complains of a pain rating of 7 on a 1-to-10 ...

[lbcchick]

A patient in labor complains of a pain rating of 7 on a 1-to-10 scale. On assessing the patient further, the nurse finds her vital signs to be within normal limits, the patient is calm and cooperative, and she voided 400 mL 30 minutes ago.
 
  What action by the nurse is best?
  A.
  Delay treating the pain until physical signs are present.
  B.
  Reassess the woman in 1 hour for changes in vital signs.
  C.
  Tell her she can have medication when the pain is unbearable.
  D.
  Treat the woman's pain according to the treatment plan.

Question 2

The perinatal nurse is caring for a Native American woman in labor with her first baby. The patient asks about the possibility of burning sweet grass, a part of her cultural tradition, during labor. Which of the following is the best response by the nurse
 
  A.
  Burning any type of substance is not allowed by policy in the hospital. Is there something else that I can do that would be similar?
  B.
  Can you explain to me a bit more about this custom and what it means to you so that I can understand it better?
  C.
  I need to confer with the charge nurse. I want to know if this practice can be allowed so I will ask to see if it is possible.
  D.
  I understand that this cultural practice is important to you; however, I am unable to accommodate your request at this time.

[lkoler]

Answer to Question 1

ANS: D
Quite simply, pain is what the patient says it is, and the nurse should treat this patient according to the treatment plan. Although there are objective signs that can be assessed with pain (changes in vital signs, emotional changes, and decreased urinary output), their absence does not invalidate the woman's complaints.

Answer to Question 2

ANS: B
When providing care, nurses must recognize that culture strongly influences how one perceives and copes with pain. Assessment of cultural beliefs and practices, questions to identify specific needs, and encouragement and support to use safe interventions is key in providing culturally sensitive care that empowers the patient to maintain her sense of control over her labor and childbirth experience. The nurse should make every attempt to accommodate this woman's request as long as safety is not compromised. If the ritual is not permitted, the nurse can work with the patient to find an acceptable alternative. Using open-ended questions is preferable to yes-no questions for gathering information.