Ch. 14 nursing mgmt during labor and birth

How should the nurse counsel a client who is about to receive meperidine 25 mg IV?

"It's possible you may feel a bit sleepy or nauseous after I administer this medication." During epidural administration, vital signs are measured every 3 to 5 minutes. For administration of analgesia, vital signs should be taken before the medication is administered and 15 minutes after administration. A baseline fetal heart tracing should be taken before administration and then again 15 minutes after administration.

The nurse has just administered butorphanol (Stadol) 2 mg IV to a laboring patient. Which change in the fetal heart rate pattern would the nurse consider to be a result of this medication?

Decreased variability Decreased variability is a common side effect when opioid analgesics are used.

A woman asks you if she can eat something during labor. Which of the following would be your best response?

"You could have some hard candy to suck on." If women are kept NPO during labor, they can be administered anesthesia safely in an emergency. Stomach-emptying time is decreased.

The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as which of the following?

Baseline FHR The baseline FHR averages 110 to 160 beats per minute over a 10-minute period. Fetal bradycardia occurs when the FHR is less than 110 beats per minute for 10 minutes or longer. Short-term variability is the beat-to-beat change in FHR. Baseline variability refers to the normal physiologic variations in the time intervals that elapse between each fetal heartbeat observed along the baseline in the absence of contractions, decelerations, and accelerations.

Which of the following is least likely to be a side effect of epidural anesthesia?

Decreased FHR variability The most common side effect of epidural anesthesia is hypotension, which can lead to fetal deceleration or fetal bradycardia, not to changes in variability. Opioid analgesia (IV or IM) is commonly associated with a change in FHR variability. Itching is a common side effect when fentanyl is used in epidurals.

You place an external fetal monitor on a woman in labor. Which of the following instructions would be best to give her?

Every 30 minutes Active labor is a phase when the cervix dilates from 4 to 8 centimeters. The contractions are progressing and occur every 2-5 minutes and last 45-60 seconds. The nurse needs to evaluate the labor pattern every 30 minutes. Longer than 30 minutes may result in missing a transition, and less than 30 minutes may be a waste of time and may cause significant inconveniences to the mother.

A nurse is caring for a pregnant client who is in the active phase of labor. At what interval should the nurse monitor the client's vital signs?

Every 30 minutes When a pregnant client is in the active phase of labor, the nurse should monitor the vital signs every 30 minutes. The nurse should monitor the vital signs every 30 to 60 minutes if the client is in the latent phase of labor and every 15 to 30 minutes during the transition phase of labor. Temperature is usually monitored every 4 hours in the active phase of labor.

When completing a routine admission on the labor and delivery unit for induction of labor, after the admission information is collected, what is the next priority in planning care for the patient?

Fetal assessment After the initial information is gathered, it is prudent to complete an assessment on the fetus. The woman is placed on a fetal monitor to check fetal heart rate and the other activities can be completed while the mother remains on the fetal monitor. Once the fetus has been assessed, the mother is then assessed and prepared for the labor process.

Mrs. Timms is ready to push. You instruct her to push vigorously by taking a deep breath and push hard while counting to 10. You tell her to do three of these maneuvers during the contraction. What would be important to monitor on Mrs. Timms while she is pushing vigorously?

Heart rate However, recent research has revealed that vigorous pushing techniques that employ the Valsalva maneuver are associated with changes in the mother's heart rate and blood pressure, and fetal oxygenation may be adversely affected.

Joanne has been in labor for 5 hours. Earlier there was a gradual increase in FHR baseline with variables, but Joanne has changed position several times and now the fetus shows no signs of hypoxia. Joanne's cervix is almost completely effaced and is dilated to 8 cm. However, the labor graph indicates that the fetus has stopped descending. What should you do first?

Palpate the area just above the symphysis pubis Palpate to determine if the infant is engaged and what the presenting part of the infant is by the symphysis pubis, it is possible for infants to rotate and change position during labor. Assess the situation and act further if necessary, but until you have more information on fetal position, assume all is going well.

Which of the following is a benefit of spinal anesthesia versus epidural anesthesia?

Spinal anesthesia is a simpler technique that will provide pain relief more quickly than epidural anesthesia. Onset of spinal anesthesia is immediate. Epidural anesthesia can take 15 to 30 minutes to provide pain relief. Epidural anesthesia can be given in a continuous dosage; spinal anesthesia is given as a one-time injection that can wear off. Both epidural anesthesia and spinal anesthesia can cause hypotension. Both can be modified to effect mobility.

There are potentially fatal complications associated with both epidural and spinal anesthesia. What is one of these complications?

Total spinal blockade Total spinal blockade is a rare but potentially fatal complication that can occur with epidural or intrathecal anesthesia. The condition results from inadvertent injection of a local anesthetic into the intrathecal space instead of the epidural space or from the anesthetic traveling too high up the woman's body, causing paralysis of the woman's respiratory muscles. Without immediate supportive care, respiratory and cardiac arrest will occur.

A primigravida, who is 1 cm dilated, is in early latent labor. She has expressed a desire to avoid epidural anesthesia and asks about nonpharmacologic options for pain relief as her labor progresses. How could the nurse appropriately respond? Select all that apply.

• "The tub usually is not recommended when you are at such an early stage because it can cause your labor to slow down. Let's talk about using the tub as your labor progresses." • "I can show you some simple breathing exercises that can help you relax." • "You may want to go for a walk now. When you come back, I'll show you how to use the birthing ball." Hydrotherapy may slow labor if used too early. Although it's often more beneficial for the patient to have practiced meditation, imagery, or breathing exercises before presenting in labor, the nurse can teach a laboring patient simple exercises when she presents in labor. Position changes and ambulation can help ease labor pains. A birthing ball helps the patient continue to change positions while her weight is partially supported.

A nurse is assigned to conduct an admission assessment on the phone for a pregnant client. Which information should the nurse obtain from the client?

• Estimated due date • Characteristics of contractions • Appearance of vaginal blood When conducting an admission assessment on the phone for a pregnant client, the nurse needs to obtain information regarding the estimated due date, characteristics of contractions, and appearance of vaginal blood to evaluate the need to admit her. History of drug abuse or a drug allergy is usually recorded as part of the client's medical history.