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Difficulty: MediumAnte/Intra/Postpartum and Newborn Care

A practical nurse is assisting with the care of a client who is in the active phase of labor at 40 weeks of gestation. The electronic fetal monitor displays a continuous pattern of late decelerations. Which action should the nurse take first?

  1. Assist the client into a lateral recumbent position.Answer
  2. B
    Independently decrease the intravenous oxytocin infusion rate.
  3. C
    Document the fetal heart rate findings and continue routine observation.
  4. D
    Explain the surgical risks to the client and obtain a signed consent for a cesarean delivery.

Answer

Assist the client into a lateral recumbent position.
Late decelerations are a concerning sign of uteroplacental insufficiency, indicating that the fetus is experiencing compromised oxygenation during contractions. Assisting the client into a lateral recumbent position is the highest priority independent action because it immediately relieves compression of the maternal vena cava and descending aorta, thereby restoring blood flow and oxygen delivery to the placenta and fetus.

Step-by-Step Solution

1
Analyze the clinical data from the fetal heart rate monitor.
The monitor shows repetitive late decelerations.
Recognizing abnormal fetal heart rate patterns is essential for identifying potential fetal distress.
2
Determine the underlying physiological cause of the decelerations.
Late decelerations are identified as a sign of uteroplacental insufficiency.
Understanding the cause (decreased oxygen delivery to the fetus) dictates the urgency and type of intervention required.
3
Identify the immediate, independent priority intervention within the practical nurse's scope of practice.
The nurse chooses to reposition the client to the lateral side.
Lateral repositioning mechanically shifts the gravid uterus off the maternal vena cava and descending aorta, rapidly improving maternal cardiac output and placental perfusion.

Key Concept

Intrapartum Fetal Monitoring and Priority Interventions
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Topics

Ante/Intra/Postpartum and Newborn Care

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