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Difficulty: Very hardAnte/Intra/Postpartum and Newborn Care

A nurse is evaluating the electronic fetal monitor tracing of a client at 41 weeks gestation who is undergoing an induction of labor with an intravenous oxytocin infusion. The tracing reveals a baseline fetal heart rate of 165 bpm with minimal variability. Over the past 20 minutes, recurrent decelerations are observed; these decelerations begin after the peak of the contraction and slowly return to baseline 30 seconds after the contraction ends. The uterine activity panel shows 7 contractions in a 10-minute window, lasting 80 to 90 seconds each, with a resting tone of 25 mm Hg. Which of the following nursing actions are appropriate? Select all that apply.

  1. Discontinue the intravenous oxytocin infusion immediately.Answer
  2. Administer a rapid intravenous bolus of isotonic crystalloid solution.Answer
  3. Prepare to administer a prescribed dose of subcutaneous terbutaline.Answer
  4. D
    Document the tracing as early decelerations and continue routine monitoring.
  5. E
    Delegate continuous observation of the electronic fetal monitor to the unlicensed assistive personnel.
  6. F
    Continue the oxytocin infusion and prepare the client for an immediate cesarean birth.

Answer

The correct actions are to discontinue the intravenous oxytocin infusion immediately, administer a rapid intravenous bolus of isotonic crystalloid solution, and prepare to administer a prescribed dose of subcutaneous terbutaline.
The client is experiencing uterine tachysystole (excessive contractions) leading to uteroplacental insufficiency, evidenced by fetal tachycardia, minimal variability, and late decelerations. Immediate intrauterine resuscitation is required. Discontinuing the oxytocin removes the stimulus causing the tachysystole. Administering an isotonic fluid bolus expands maternal intravascular volume to maximize placental perfusion. Preparing terbutaline (a tocolytic) is appropriate to relax the uterine muscle if stopping oxytocin is insufficient.

Step-by-Step Solution

1
Analyze the fetal heart rate baseline and variability.
The baseline is 165 bpm (fetal tachycardia) with minimal variability.
Normal baseline is 110-160 bpm with moderate variability. These abnormal findings indicate potential fetal compromise or hypoxia.
2
Identify the type of decelerations present on the tracing.
The decelerations begin after the peak of the contraction and return to baseline slowly, defining them as late decelerations.
Late decelerations are a hallmark sign of uteroplacental insufficiency and require immediate intervention.
3
Evaluate the uterine activity panel.
The presence of 7 contractions in a 10-minute window, lasting up to 90 seconds each with an elevated resting tone of 25 mm Hg.
This pattern constitutes uterine tachysystole (defined as more than 5 contractions in 10 minutes), which impairs blood flow to the placenta.
4
Select priority interventions for intrauterine resuscitation.
The appropriate actions are stopping the oxytocin, administering an IV fluid bolus, and preparing a tocolytic like terbutaline.
These specific actions directly reduce uterine activity, increase maternal blood volume, and improve placental perfusion, addressing the root cause of the fetal distress.

Key Concept

Intrauterine Resuscitation for Uterine Tachysystole
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Topics

Ante/Intra/Postpartum and Newborn Care

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