Maternity Nursing: Intrapartum Q 5
A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of slowing labor. The nurse is reviewing the physician’s orders and would expect to note which of the following prescribed treatments for this condition?
A. Medication that will provide sedation
B. Increased hydration
C. Oxytocin (Pitocin) infusion
D. Administration of a tocolytic medication
Correct Answer: C. Oxytocin (Pitocin) infusion.
Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate labor that slows. Hypotonic labor is an abnormal labor pattern, notable especially during the active phase of labor, characterized by poor and inadequate uterine contractions that are ineffective to cause cervical dilation, effacement, and fetal descent, leading to a prolonged or protracted delivery.
Option A: Provided there are no contraindications. Oxytocin is the medication of choice for augmenting contractions. The dosage regimen should be titrated to effect for achieving adequate uterine contractions. However, dosing generally does not exceed 30milliunit/ minute. The usual protocol is 5 units of oxytocin in 500mls of 5% Dextrose intravenous infusion, starting with 10 drops/min and gradually titrating the rate to achieve a contraction rate of at least 3 per minute.
Option B: Maintain adequate hydration. Encourage ambulation and avoid supine position. Although these are not proven to improve contractions or prolonged labor due to hypocontractility, they may improve the comfort of the patient.
Option D: A combination of amniotomy and oxytocin augmentation is more effective in the management of hypocontractile labor than amniotomy alone when instituted early in the active phase.