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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

A common physilogic effects of epidural and spinal anasthesia is hypotension primerly due to blockage of the sympathetic nervous system causing arterial and venous vasodilation with subsequent functional hypovolumia.

Nursing diagnosis are,

Hypotension and shock related to effect of epidural block

Risk for hypovolumia related to the the vasodialation.

Alterd consious level related to hypovolimia

Knowledge deficit of reatives related to the condition

Nursing interventions'

Access the condition of the patient blood pressure and vital sign

stop the infusion if the blood pressure is very low

accese the central venus pressure

Start plasma expanders if hypotention persist

Give the health education and psychological support to the patient relatives

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