A client with a suspected small pelvis is dilated at 6 cm. The fetus has an estimated weight of 4200 g (9 lb, 4 oz). What is the most important action for the client at this time?
1. Encourage oral fluids and carbohydrate intake.
2. Assess the cervix for change every 8 hours.
3. Inform the couple that labor might be prolonged.
4. Assist the client to squat during the second stage.
4
Explanation:
1. A client with a large fetus and a small pelvis has a higher-than-average chance of needing a cesarean section. This client should either be given only clear liquids or be NPO to reduce the risk of aspiration should a cesarean section need to be performed.
2. The cervix is normally assessed when the client's labor status appears to have changed, or in order to determine whether cervical change is taking place. The cervix would be assessed more frequently if a client was in the active phase of labor and cephalopelvic disproportion was a risk. Every 8 hours is too far apart.
3. Although it is true that labor with a large fetus and a small pelvis could be prolonged, informing the couple of this fact is a psychosocial intervention. Physiologic interventions are a higher priority.
4. Squatting increases the diameter of the pelvic outlet and might facilitate vaginal birth when cephalopelvic disproportion is a risk.
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