Question

Giselel is a 30-year-old G1P0 admitted at39 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. Nurse should explain Giselel that this pain is for sometime and every mother has to ber this type of pain. Since it is her first baby she is more anxious. Nurse should ask her to inhale and exhale so the pain is lesser. Also partner to stay with her and calm her down and support her.

2. Nurse must have explained her about epidural and I pain Medication earlier before she landed up in the pain. Pain medication will help relieve the pain. Nurse should tell her that IV medications would be going through the veins and epidural would be from the spinal cord.

3. Butarphanol is opoid analgesic used to treat moderate to severe pain. Before administering the drug she should check if gieseles has history of asthma, bowel obstruction, and other underlying disorder. Butarphanol can pass through breast milk and may cause drowsiness. So check for such signs. Also check for normal breathing. overdose can be fatal. Hence all precautions needs to be taken.

4.the nurse should anticipate the onset of second stage of labour. She should check the head of the baby and be prepared for labour with all necessary supplies like warmer to be checked, baby tray , injection oxytocin if required, IV fluids, episiotomy tray in case required. She may call for assistance.