Induction of labor is planned for a 31-year-old primip at 39 weeks due to insulin-dependent diabetes. What nursing action is most important?
1. Administer 100 mcg of misoprostol (Cytotec) vaginally every two hours.
2. Place dinoprostone (Prepidil) vaginal gel and ambulate client for one hour.
3. Begin Pitocin (oxytocin) four hours after 50 mcg misoprostol (Cytotec).
4. Prepare to induce labor after administering a tap water enema.
3
Rationale:
1. Misoprostol (Cytotec) is administered in 25mcg doses every 3–6 hours. 100 mcg every two hours is too much medication too frequently.
2. The client must remain recumbent for two hours after administration of dinoprostone (Prepidil) vaginal gel, during which time continuous monitoring is undertaken.
3. A minimum of four hours must elapse between the last dose of misoprostol (Cytotec) and beginning Pitocin administration; thus the timing of these two medications is appropriate.
4. Enemas are not routinely used in labor. This order is not expected.
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