You are preparing a client for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.)
a. Administer a bolus of 500 to 1000 mL of D5 normal saline prior to catheter placement.
b. Have ephedrine available at bedside during catheter placement.
c. Monitor blood pressure of client frequently during catheter insertion and for the first 15 minutes of epidural administration.
d. Insert a Foley catheter prior to epidural catheter placement.
e. Monitor the client for hypertension in response to epidural insertion.
ANS: B, C
A bolus of nondextrose fluid is recommended prior to epidural administration to prevent maternal hypotension. Ephedrine should be available at the bedside in case maternal hypotension is exhibited. Blood pressure should be monitored frequently during insertion and for the first 15 minutes of therapy. It is not necessary to insert a Foley catheter prior to epidural catheter placement. Hypertension is not a common clinical response to this treatment but hypotension is.
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