The nurse is caring for a client in the first stage of labor
Item 1 of 1
- Nurses' Notes
1800: A 31-year-old primigravida at 38 gestational weeks 100% effaced and 2 cm dilated. Contractions occur every 15 minutes lasting for 20 seconds. The client reports that the contractions are becoming more painful and alternate between cramping and pressure.
1825: Informed consent was obtained by the physician for a planned epidural catheter with the administration of analgesia. Signature was witnessed by the RN. Continuous external fetal monitoring was applied. Normal variability was noted with the fetal heart rate of 110-130/minute.
- Vital Signs
Temperature 98.0° F (37° C)
Pulse 91/minute
Respirations 16/minute
Blood Pressure 138/76 mm Hg
Oxygen saturation 95% on room air
Drag (1) one condition and (1) assessment to fill in each blank of the following sentence
Drag (1) one condition and (1) assessment to fill in each blank of the following sentence
Immediately following the placement of the epidural, the client is at the highest risk for
and the nurse anticipates a prescription for
Conditions
- hypertension
- infection
- early decelerations
- hyperglycemia
Anticipated Prescriptions
- regular insulin.
- magnesium sulfate.
- broad-spectrum antibiotics
- internal fetal monitoring
Statistics
Subject/Lesson
Subject
Maternal & Newborn Health
Lesson
Labor/Delivery
Client Need
Test Plan
Reduction of Risk Potential
Related Topic
Potential for Complications of Diagnostic Tests/Treatments/Procedures
Item Type
Item Type
PrioritizeHypothesis
Explanation
- The most common adverse maternal effect associated with epidural analgesia is the development of maternal hypotension. This effect can be mitigated by infusing 0.9% saline bolus pre-procedurally.
- Alternatively, lactated ringers may be used instead of 0.9% saline.
- Infection may occur with an epidural, but this would not be seen immediately following its placement. Antibiotics are not routinely given before the initiation of epidural analgesia.
- This type of analgesia would not cause early fetal decelerations or maternal hyperglycemia.
Related Videos
2 Key Topics
Pain Control in Labor
30.3 Labor Management & Pain Control
Additional Info
For lumbar epidural analgesia, the common site selected is between L3 to L4. Essential monitoring parameters include the area for signs of infection, blood pressure (may cause hypotension), and urinary output (may cause urinary retention).
