The labor nurse is providing care for a patient admitted for induction of labor at 38 weeks' gestation. The patient's Bishop score is 5, and an infusion of oxytocin (Pitocin) is initiated with orders that read as follows:

Question

mix 30 units of Pitocin in 500 mL of NS, increase the rate of infusion by 2 mL/hr every 15 to 60 minutes until a pattern of three contractions in 10 minutes is established. What is the priority nursing action for this patient?

a. Increase the infusion of Pitocin every 30 to 60 minutes.
b. Assess for changes in the patient's cervix every 2 hours.
c. Obtain a reactive non–stress test prior to starting the infusion.
d. Determine the fetal heart rate baseline for 30 minutes prior to starting the infusion.

Answer 1

ANS: A
Cervical assessment estimates whether the cervix is favorable for induction. The Bishop scoring system is used to estimate cervical readiness for labor with five factors—cervical dilation, effacement, consistency, position, and fetal station. Vaginal birth is more likely to result if the Bishop score is higher than 8. This patient's Bishop score is low and she is at increased risk for an operative birth. Titration of Pitocin is at the judgment of the RN. A slower infusion of Pitocin allows more time for her body to adapt to the Pitocin and increases her potential for a nonoperative birth. Pitocin is a rapid-acting drug with an onset of 1 minute, duration of 30 minutes, and a half-life of 12 to 17 minutes. Cervical assessment is completed on an as-needed basis and is not scheduled. Assuring fetal well-being is important and can be determined by variability in the FHR baseline. A reactive non–stress test is not necessary prior to infusion. Establishing a baseline FHR prior to induction is a standard of care.