The charge nurse is reviewing the plans of care for four laboring patients. Which care plan requires immediate reconsideration for revision?

Question

1. Administration of epidural anesthesia to a woman who is in the first stage of labor and has a shellfish allergy
2. Administration of a spinal anesthetic to a woman who is scheduled for vaginal delivery of her baby
3. Administration of epidural anesthesia to a woman with a history of vomiting secondary to hyperemesis gravidarum
4. Administration of a spinal anesthetic to a woman with a history of irritable bowel syndrome (IBS)

Answer 1

Correct Answer: 3
Rationale 1: A lumbar epidural relieves pain associated with the first and second stages of labor. An allergy to shellfish is not a contraindication to epidural anesthesia.
Rationale 2: Spinal anesthetics may be used to provide anesthesia for cesarean birth and occasionally for vaginal birth.
Rationale 3: Contraindications to epidural anesthesia include severe hypovolemia of any etiology. This patient with hyperemesis gravidarum should be evaluated for severity of dehydration prior to administration of epidural anesthesia.
Rationale 4: Irritable bowel syndrome (IBS) does not represent a contraindication to spinal anesthesia.