Question

Giselel is a 30-year-old G1P0 admitted at 39 weeks of gestation in early active labor. Her cervical examination is 3/100/-1 vertex. Her membranes are intact. Her contractions are every 4 minutes x 60 seconds. Fetal heart tones are 140 with moderate variability, accelerations present, no deceleration's. She declines medication for pain at this time, but states she might need something later. Her partner at the bedside seems anxious.

1. How can the nurse help Gisellen cope with the pain of contractions at this time in labor?

2. 4 hours later Giselle's contractions are every 3 minutes and much stronger. Her cervix is now 6cm/100/0 station. She is requesting medication for pain but is not sure if she wants an epidural or IV pain medication. How can the nurse counsel her regarding her choices?

3. Giselle decides to utilize IV pain medications and the nurse-midwife orders 2 g of butorphanol IV. What should the nurse do to manage the administration of the medication safely and the subsequent care of the patient?

4. Giselle suddenly feels the urge to push and experiences spontaneous rupture of membranes 1 hour after administration of the butorphanol. The nurse-midwife examines her and finds she is completely dilated with the vertex at +2 station. What should the nurse anticipate? What preparations and plans should be made?

Answer 1

1) The nurse can help Gisellen cope with the pain of contractions by the following ways :-

- use of warm compress

- deep breathing exercise

- walking

2) The nurse should provide her information about the epidural analgesic and IV analgesic , how it works , how much time will it take what are the side effects etc. Then based on that decision has to be made . Since , epidural analgesia has many side effects like Decreased gastric emptying resulting in nausea and vomiting. Inhibition of bowel and bladder elimination sensations Bradycardia or tachycardia, Hypotension ,Respiratory depression , it's better to opt for IV analgesic .

3) The nurse should follow the IV administration procedure to manage the administration of the medication safely

Nursing Actions

MonitorCNS,cardiac and respiratory status closely

Initiate modified fall precautions

Monitor neonate for respiratory and cardiac depression

4. It means the client is in the second stage of labor . The nurse should prepare the delivery room and shift her to delivery room .