A patient in active labor requests an epidural for pain ...

[PhilipSeeMore]

A patient in active labor requests an epidural for pain management. What is the nurse's priority action for this patient?
 
  a. Assess the fetal heart rate pattern over the next 30 minutes.
  b. Take the patient's blood pressure every 5 minutes for 15 minutes.
  c. Determine the patient's contraction pattern for the next 30 minutes.
  d. Initiate an IV infusion of lactated Ringer's solution at 2000 mL/hr over 30 minutes.

Question 2

You are preparing a client for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.)
 
  a. Administer a bolus of 500 to 1000 mL of D5 normal saline prior to catheter placement.
  b. Have ephedrine available at bedside during catheter placement.
  c. Monitor blood pressure of client frequently during catheter insertion and for the first 15 minutes of epidural administration.
  d. Insert a Foley catheter prior to epidural catheter placement.
  e. Monitor the client for hypertension in response to epidural insertion.

[abro1885]

Answer to Question 1

ANS: D
Rapid infusion of a nondextrose IV solution, often warmed, such as lactated Ringer's or normal saline, before initiation of the block fills the vascular system to offset vasodilation. Preload IV quantities are at least 500 to 1000 mL infused rapidly. Vasodilation with corresponding hypotension can reduce placental perfusion and is most likely to occur within the first 15 minutes after the initiation of the epidural. Determining the fetal heart rate every 30 minutes is the standard of care. The patient is in active labor, which indicates a contraction pattern resulting in cervical dilation.

Answer to Question 2

ANS: B, C
A bolus of nondextrose fluid is recommended prior to epidural administration to prevent maternal hypotension. Ephedrine should be available at the bedside in case maternal hypotension is exhibited. Blood pressure should be monitored frequently during insertion and for the first 15 minutes of therapy. It is not necessary to insert a Foley catheter prior to epidural catheter placement. Hypertension is not a common clinical response to this treatment but hypotension is.