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A patient on the L&D unit has been in labor for four hours with an epidural...

A patient on the L&D unit has been in labor for four hours with an epidural block for pain management for the last hour. The patient’s blood pressure has been averaging 125/70 to 130/72. During a routine nursing assessment, the patient’s blood pressure has decreased to 100/60 and the fetal heart rate pattern exhibits a decrease in variability with an occasional late deceleration.

  1. What is the physiologic basis for what is happening?
  2. What is a priority nursing diagnosis related to this event?
  3. What are the immediate nursing actions that the nurse should do? (Remember the physiologic changes that are occurring.)
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Answer #1

1.What is the physiologic basis for what is happening?

Low blood pressure that causes an inadequate flow of blood to fetus and also to the different body organs. It is because of the reduced blood volume. The altered uteroplacental perfusion causes fetal distress and it shows fetal decelerations on non stress test.

2.What is a priority nursing diagnosis related to this event?

Impaired uteroplacental tissue perfusion related to maternal hypovolemia and interruption of blood flow

3.What are the immediate nursing actions that the nurse should do?

  • Assess the fetal heart rate
  • Position the patient in left lateral position to increase the oxygen delivery to fetus
  • Administer oxygen to the patient.
  • Evaluate the fetal growth
  • Monitor NST

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