A nurse on a labor and delivery unit is caring for a client…
A nurse on a labor and delivery unit is caring for a client who is at 39 weeks of gestation and is in the first stage of labor. Nurses Notes1200: Client is 6 cm dilated, 70% effaced, and at 0 station. Membranes are intact. Contractions are occurring every 2 to 3 min, strong to palpation. Fetal heart rate (FHR) is 140 to 145/min with average variability. FHR abruptly decreases to 100 beats per min with contractions, lasts 15 seconds, and returns to baseline within 30 seconds. Medical History0530: Client is 26-year-old, Gravida 3, Para 2 , and is at 39 weeks gestation. The client is being induced for oligohydramnios. The client has no significant social or medical history. The only complication with this pregnancy is oligohydramnios. Client has previously delivered a 7 lb 5 oz infant vaginally without complications. Upon admission, the client is 1 cm dilated, 40% effaced, and -2 station. No bloody show observed. Vital Signs 1000: Blood pressure 122/74 mm HgPulse 98/min, strong and regularRespiratory rate 20/min even and unlaboredTemperature 36.7° C (98.1° F)Oxygen saturation 99% on room air 1. What is the potential complication? Select one appropriate letter. A. late fetal heart rate decelerationsB. prolonged fetal heart rateC. variable fetal heart rate decelerationsD. early fetal heart rate decelerations 2. What 2 actions should the nurse take? Select 2 appropriate letters.E. turn the client to their left sideF. administer oxygen at 7-10 L/min via non-rebreather facemaskG. insert misoprostol into the posterior vaginal fornixH. initiate amnioinfusionI. continue to monitor fetal heart rate 3. What 2 priority parameters should the nurse monitor? Select 2 appropriate letters.J. mother’s emotional statusK. mother’s urinary outputL. fetal heart rate baselineM. mother’s temperatureN. fetal heart rate variability For your answer, you need to write the correct letters like this:1.__2.__ __3.__ __
Read Details