The client in labor has moderately strong contractions lasting 60 seconds every 3 minutes. The fetal head is presenting at a 2 station. The cervix is 6 cm and 100 effaced. The membranes spontaneously ruptured prior to admission, and clear fluid is leaking. Fetal heart tones are in the 140s with accelerations to 150. Which nursing action has the highest priority?
1. Obtain a clean-catch urine specimen.
2. Apply an internal fetal scalp electrode.
3. Keep the client on bed rest at this time.
4. Encourage the husband to remain in the room.
Question 2
An expectant father has been at the bedside of his laboring partner for more than 12 hours. What would be an appropriate nursing intervention?
1. Insist that he leave the room for at least the next hour.
2. Offer to remain with his partner while he takes a break.
3. Suggest that the client's mother might be of more help.
4. Tell him he is not being as effective as he was and that he needs to let someone else take over.
Client on IV patient-controlled analgesia (PCA).
Use face cradle covers to prevent the client’s skin from touching the face cradle upholstery.
Stand at the side facing the client. Apply L stroke to both sides of the neck with flat fingers ...
Survey and posture of client: Lateral view
Fetal Period