Which nursing action can prevent or detect common side effects of ...

[nenivikky]

Which nursing action can prevent or detect common side effects of epidural anesthesia? Select all that apply.
 
  1. Preloading the client with a rapid infusion of IV fluids
  2. Continuing the client on oral fluids only to prevent hypotension
  3. Assisting the client to empty the bladder before the anesthesia is started
  4. Use of intermittent fetal heart rate (FHR) monitoring so the client can use the birthing ball
  5. Monitoring the fetal heart rate (FHR) for late deceleration and decrease in rate

Question 2

The charge nurse is reviewing the plans of care for four clients in labor. Which care plan requires additional information before implementing?
 
  1. Administration of a spinal anesthetic to a client who is scheduled for a vaginal delivery
  2. Administration of a spinal anesthetic to a client with a history of irritable bowel syndrome (IBS)
  3. Administration of epidural anesthesia to a client who is in the first stage of labor and has a shellfish allergy
  4. Administration of epidural anesthesia to a client with a history of vomiting secondary to hyperemesis gravidarum

[taylorsonier]

Answer to Question 1

1, 3, 5
Explanation:
1. Hypotension can be prevented by preloading with rapid IV infusion followed by continuous IV infusion.
2. Hypotension can be prevented by preloading with rapid IV infusion followed by continuous IV infusion. The amount of oral fluids that would be required to prevent hypotension makes this approach inappropriate for the client in labor.
3. The epidural decreases the urge to urinate. The client's bladder should be assessed frequently for distention.
4. Hypotension can be prevented by preloading with rapid IV infusion followed by continuous IV infusion. Variability of FHR and late decelerations can occur if maternal hypotension occurs. Continuing FHR monitoring is essential.
5. Hypotension can be prevented by preloading with rapid IV infusion followed by continuous IV infusion. Variability of FHR and late decelerations can occur if maternal hypotension occurs. Continuing FHR monitoring is essential.

Answer to Question 2

4
Explanation:
1. Spinal anesthetics may be used to provide anesthesia for cesarean birth and occasionally for vaginal birth.
2. Spinal anesthesia is not contraindicated for irritable bowel syndrome (IBS).
3. A lumbar epidural relieves pain associated with the first and second stages of labor. An allergy to shellfish is not a contraindication to epidural anesthesia.
4. Contraindications to epidural anesthesia include severe hypovolemia of any etiology. The client with hyperemesis gravidarum should be evaluated for severity of dehydration prior to administration of epidural anesthesia.