A client at 39 weeks' gestation was assessed 2 hours ago as being 3 cm dilated, 40% effaced, and +1 station and experienced contractions every 5 minutes with duration 40 seconds and intensity 50 mmHg
Currently, the client is 4 cm dilated, 40% effaced, and +1 station with frequency of contractions every 3 minutes with 40 to 50 seconds' duration with intensity of 40 mmHg. What action should the nurse make a priority at this time? 1. Start oxygen at 8 L/min.
2. Give terbutaline to stop the preterm labor.
3. Have anesthesia provider give the client an epidural.
4. Begin oxytocin after assessing for cephalopelvic disproportion (CPD).
4
Explanation:
1. Oxygen will not hurt, but it is not the priority.
2. Terbutaline would not be recommended. The contraction pattern is incoordinate, but they need to be enhanced, not stopped.
3. An epidural will not change the incoordinate contraction pattern.
4. The client is having hypertonic contractions. The presence of CPD can prolong labor, so it is important to rule this out. Oxytocin (Pitocin) can create a more productive labor pattern by strengthening the contractions.
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