Final answer:
When a client in active labour with epidural anaesthesia experiences nausea and a drop in BP, the nurse should reposition the client, increase IV fluids, administer oxygen if needed, mobilize healthcare personnel for additional interventions such as vasopressors, monitor fetal heart rate, and notify the anaesthesia and obstetric team.
Step-by-step explanation:
When a client in active labour receiving epidural anaesthesia reports feeling nauseated and experiences a significant drop in blood pressure, indicative of hypotension, the nurse should first remain calm and reassure the client. Prompt assessment and intervention are critical to ensure the safety of both the mother and the developing fetus. The first actions should include:
- Checking the client's position to ensure she is not lying flat on her back, which may contribute to hypotension due to inferior vena cava compression by the uterus. Repositioning to the left lateral position can aid venous return and improve blood pressure.
- Increasing intravenous fluid rate, if applicable, to expand the intravascular volume and help to raise the blood pressure.
- Administering oxygen to the client might be considered to ensure adequate oxygenation for both the mother and the fetus.
- Mobilizing additional healthcare personnel if the situation does not improve or worsens, potentially preparing for the administration of vasopressors, as ordered by the physician or anesthesia provider.
- Continuous fetal heart monitoring to assess fetal status, as maternal hypotension can lead to decreased placental perfusion and fetal distress.
- Notifying the anaesthesiologist or nurse anaesthetist and the client's obstetrician of the situation, as they may need to make additional therapeutic decisions or interventions.
It is important to monitor and document the client's blood pressure, heart rate, respiratory rate, and fetal heart rate closely after initiating these interventions. The healthcare team should remain vigilant to any changes in the client's status and respond accordingly.