Maternity Nursing: Intrapartum Q 37
A multiparous client who has been in labor for 2 hours states that she feels the urge to move her bowels. How should the nurse respond?
A. Let the client get up to use the potty
B. Allow the client to use a bedpan
C. Perform a pelvic examination
D. Check the fetal heart rate
Correct Answer: C. Perform a pelvic examination
A complaint of rectal pressure usually indicates a low presenting fetal part, signaling imminent delivery. The nurse should perform a pelvic examination to assess the dilation of the cervix and station of the presenting fetal part.
Option A: During labor a lot of pressure may be exerted on the fallopian tubes, ovaries, and ligaments. The baby’s presenting part (usually the head) pressed firmly against the bladder and bowel as he descends through the pelvis. This can lead to great pain, particularly if the woman doesn’t empty the bladder frequently. About once an hour is a good rule to remember.
Option B: Labor is usually painful for several very good reasons. For one, the cervix, completely insensitive to burning and cauterization, is nevertheless extremely sensitive to pressure and stretching–precisely what it undergoes during labor. Most women feel contractions as cramping sensations in the groin or back, though some experience more pain in their sides or thighs. As the contractions get longer, stronger, and closer together over the course of labor, they will be perceived as more or less painful by different women.
Option D: When the woman lies on her back for long periods of time, the weight of the uterus compresses the descending aorta and inferior vena cava, blood vessels that supply or drain the lower part of the body. This interference with the circulation reduces the blood pressure, compromising blood flow to the baby and causing his heart rate to drop. When the woman stays upright (or at least off her back), placental circulation improves and fetal heart rate abnormalities may be alleviated.