The labor and delivery nurse is reviewing charts. Of which client should the nurse inform the supervisor?
1. Multip at 5 cm requesting labor epidural analgesia
2. Primip whose cervix remains at 6 cm for four hours
3. Multip who has developed nausea and vomiting
4. Primip requesting her partner to stay with her
2
Rationale:
1. Contacting the supervisor is required when an abnormal situation is present. A multip requesting an epidural at 5 cm is not abnormal.
2. Average cervical change among primips in the active phase of the first stage of labor is 1.2 cm/hour; thus this client's lack of cervical change is unexpected, and should be reported to the supervisor.
3. Nausea and vomiting are common during the transitional phase of the first stage of labor. Contacting the supervisor is required only when an abnormal situation is present.
4. Clients in the transitional phase of the first stage of labor often fear being left alone; this is an expected finding. Contacting the supervisor is required only when an abnormal situation is present.
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