Author Question: The laboring patient brought a written birth plan indicating that she wanted to avoid pain ... (Read 44 times)

lb_gilbert · **on:** Jun 27, 2018

The laboring patient brought a written birth plan indicating that she wanted to avoid pain medications and an epidural.

She is now at 6 cm and states, I can't stand this anymore I need something for pain How will an epidural affect my baby? The best response by the nurse is: 1. The narcotic in the epidural will make both you and the baby sleepy.
2. It is unlikely that an epidural will decrease your baby's heart rate.
3. Epidurals tend to cause low blood pressure in babies after birth.
4. I can't get you an epidural, because of your birth plan.

Question 2

The nurse assesses that a newborn's skin has a ruddy appearance and the peripheral pulses are decreased. The nurse suspects polycythemia. Which lab report might indicate that the newborn has polycythemia?

1. Central venous hematocrit level greater than 65
2. Bilirubin level of 6 mg/dl
3. Venous hemoglobin level lower than 12 g/dl
4. Blood glucose level of 44 mg/dl

jsm54321 · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

2
Rationale 1: It is rare for sedation to occur from absorption of the medications of a continuous epidural.
Rationale 2: If the mother becomes hypotensive, the fetal heart rate can become bradycardic. IV hydration prior to the epidural and positioning the mother with a lateral tilt would help prevent this problem.
Rationale 3: Mothers can experience hypotension after the epidural is administered, but babies do not develop hypotension after birth as a result of a labor epidural.
Rationale 4: A birth plan is what the patient hopes for prior to the onset of labor, but it can be modified at any time.

Answer to Question 2

1
Rationale 1: A venous hematocrit level greater than 65 indicates polycythemia.
Rationale 2: This bilirubin level is within normal limits.
Rationale 3: A venous hemoglobin level lower than 12 g/dl indicates anemia.
Rationale 4: This blood glucose level is within normal limits.