Health Promotion and Maintenance Q 118
A client elects to have epidural anesthesia to relieve the discomfort of labor. Following the initiation of epidural anesthesia, the nurse should give priority to:
A. Checking for cervical dilation
B. Placing the client in a supine position
C. Checking the client’s blood pressure
D. Obtaining a fetal heart rate
Correct Answer: C. Checking the client’s blood pressure
Following epidural anesthesia, the client should be checked for hypotension and signs of shock every 5 minutes for 15 minutes. Monitoring the patient’s hemodynamic status during and after the procedure is very important. The minimum monitors required are pulse oximeter for pulse and oxygen saturation as well as blood pressure cuff and continuous EKG to assess cardiovascular status.
Option A: The client can be checked for cervical dilation later after she is stable. A certified nurse presence is very important during and after the procedure to monitor the patient and baby (labor epidural analgesia) and to detect early signs of complications.
Option B: The client should not be positioned supine because the anesthesia can move above the respiratory center and the client can stop breathing. The patient’s position plays a pivotal role in the procedure’s success. Epidural placement can be performed more commonly in a lateral decubitus and sitting position or less frequently in the prone position. In the lateral decubitus position, the patient is completely resting on their side on the bed surface, and the spine is parallel to that surface as well. Thighs and neck are flexed forward, imitating fetal position.
Option D: Fetal heart tones should be assessed after the blood pressure is checked. The physical exam focused on the spine is important to notice infection of the area and anatomical abnormalities or variations that can potentially affect the procedure. All the monitors must be placed and working, intravenous access placed, time out should take place before the procedure, and asepsis and antisepsis must be maintained. Risks must be discussed, and informed consent obtained.