Client is at 38 weeks' gestation, gravida 1, para 0, vaginal ...

[dbose]

Client is at 38 weeks' gestation, gravida 1, para 0, vaginal exam4 cm, 100 effaced, +1 station vertex. What is the most likely intervention for this fetal heart rate pattern?
 
  a. Continue oxytocin (Pitocin) infusion.
  b. Contact the anesthesia department for epidural administration.
  c. Change maternal position.
  d. Administer Narcan to client and prepare for immediate vaginal delivery.

Question 2

The physician has ordered an amnioinfusion for the laboring client. What data supports the use of this therapeutic procedure?
 
  a. Presenting part not engaged
  b. +4 meconium-stained amniotic fluid on artificial rupture of membranes (AROM)
  c. Breech position of fetus
  d. Twin gestation

[aadams68]

Answer to Question 1

ANS: C
Late decelerations indicate fetal compromise (uteroplacental insufficiency) and are considered to be a significant event requiring immediate assessment and intervention. Of all the options listed, changing maternal position may increase placental perfusion. In the presence of late decelerations, Pitocin infusion should be stopped. Contacting anesthesia for epidural administration will not solve the existing problem of late decelerations. There are no data to support the administration of Narcan and because client is still in early labor, birth is not imminent.

Answer to Question 2

ANS: B
Amnioinfusion is a procedure used during labor when cord compression or the detection of gross meconium staining is found in the amniotic fluid. A saline solution is used as an irrigation method through the IUPC (intrauterine pressure catheter).