A nurse is assisting with an amnioinfusion. What critical nursing ...

[maychende]

A nurse is assisting with an amnioinfusion. What critical nursing actions are included in this procedure? (Select all that apply.)
 
  A.
  Assessing the maternal temperature
  B.
  Assembling equipment
  C.
  Documenting fluid exiting the vagina
  D.
  Maintaining sterile technique
  E.
  Monitoring the fetal heart rate

Question 2

A nurse notes variable decelerations on the fetal heart monitor and is explaining them to the laboring woman and her partner. What information about these patterns does the nurse share? (Select all that apply.)
 
  A.
  Last at least 15 seconds
  B.
  Least common type of deceleration pattern
  C.
  May be a result of cord compression
  D.
  Occur at any time during a contraction
  E.
  Return to baseline within 4 minutes

[sylvia]

Answer to Question 1

ANS: A, B, C, E
The critical nursing actions during this procedure are assembling the equipment; monitoring the fetal heart rate, contraction status, and maternal temperature; and verifying and documenting that the infused fluid exits the vagina. The nurse is not performing the procedure; it is up to the provider to maintain sterile technique. Of course the nurse should be vigilant that sterile technique is not breached.

Answer to Question 2

ANS: A, C, D
Variable decelerations are inconsistent in the onset, peak, duration, and intensity. They are the most common type of deceleration pattern seen in labor. They last at least 15 seconds, occur any time during a contraction, and may be the result of cord compression. They return to baseline within 2 minutes.