During her hospital admission, the laboring patient explicitly refused all pain medications and a labor epidural
Once dilated to 5 cm, the patient complains of intolerable discomfort and asks the nurse, "If I have an epidural, how will you make sure it doesn't hurt my baby?" The best response by the nurse is:
1. "We'll monitor your baby continuously so we can recognize and treat any changes that may be related to the epidural."
2. "Epidural anesthesia is very safe and there are no potential side effects that can affect your baby."
3. "We'll assess your blood pressure every 15 minutes to make sure the epidural is not having any negative effects on your baby."
4. Before your epidural is placed, we'll administer IV fluid to you in order to prevent the epidural from causing you problems."
Correct Answer: 1
Rationale 1: Continuous electronic fetal monitoring to assess fetal status is indicated in the care of pregnant women who receive epidural anesthesia and allows for a more direct assessment of fetal status than does frequent monitoring of maternal BP and pulse, which are also indicated in the care of this patient.
Rationale 2: While proficient administration and monitoring of epidural anesthesia allows for a high degree of safety with this technique, maternal hypotension associated with epidural anesthesia may produce harmful fetal effects.
Rationale 3: While frequent monitoring of maternal blood pressure and pulse are indicated in the care of a patient who receives a labor epidural, continuous electronic fetal monitoring is also indicated for assessment of fetal status and allows for a more direct fetal assessment.
Rationale 4: While administration of a bolus of IV fluid is indicated in preparation for epidural placement and reduces the risk for maternal hypotension, this intervention neither guarantees the prevention of related complications nor allows for assessment of fetal status.
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