Maternity Nursing: Intrapartum Q 6
A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to:
A. Monitor the Pitocin infusion closely
B. Provide pain relief measures
C. Prepare the client for an amniotomy
D. Promote ambulation every 30 minutes
Correct Answer: B. Provide pain relief measures
Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern. The psychological preparation of patients before labor appears to improve pain tolerance during labor. This should begin during routine antenatal visits and the counseling for labor analgesia. This preparation may serve to reduce the need for neuraxial analgesia in labor, which is a probable predisposing factor for hypocontractile labor.
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.
Option C: Membrane rupture (amniotomy) stimulates contractions by the release of prostaglandins and reflex stimulation of the uterus when the presenting part becomes closely applied to the lower uterine segment. Amniotomy should be attempted when vaginal delivery is probable; where cervical dilatation > 4 cm, there is adequate fetal descent (station -2 or lower), and the presenting part is well-applied to the lower uterine segment.
Option D: 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.