Question

A nurse is evaluating the fetal monitoring strip of a laboring primigravida at 38 weeks gestation who is receiving an oxytocin infusion and has external fetal monitors and an intrauterine pressure catheter in place. The client is experiencing late decelerations. Which of the following interventions should the nurse implement? Select all that apply.

1. Administer supplemental oxygen by mask
2. Initiate an IV bolus of 0.9% saline
3. Prepare for amnioinfusion
4. Reposition the client to supine
5. Stop the oxytocin infusion

Answer 1

The nurse should administer supplemental oxygen, initiate an IV bolus of saline, reposition the client to the lateral position, and stop the oxytocin infusion in response to late decelerations on a fetal monitoring strip of a laboring primigravida.

Step-by-step explanation:

When a nurse is evaluating the fetal monitoring strip of a laboring primigravida and notes the presence of late decelerations, there are specific interventions the nurse should implement to address the situation. Late decelerations can indicate uteroplacental insufficiency, and prompt intervention is required to ensure fetal well-being.

• Administer supplemental oxygen by mask to increase fetal oxygen delivery.
• Initiate an IV bolus of 0.9% saline to expand intravascular volume and improve placental blood flow.
• Reposition the client to a lateral position, usually left lateral, to optimize uterine perfusion and reduce compression of the vena cava and aorta.
• Stop the oxytocin infusion, as oxytocin can increase the frequency and intensity of contractions, potentially reducing placental blood flow and exacerbating late decelerations.

Preparing for amnioinfusion may be considered if there is evidence of oligohydramnios contributing to cord compression; however, this intervention requires additional clinical judgment and may not always be applicable. It should not be done before ensuring fetal oxygenation, hydration, and maternal circulation are addressed. Avoid repositioning the client to supine due to the risk of supine hypotensive syndrome, which can further compromise uteroplacental perfusion.