epidural and decel question

[JadeRN7]

My question is when a decel occurs immediately following an epidural loading dose, is it wrong to let the pt know that the epidural can cause this? I was told by the charge nurse to never let the pt know that and I can't understand why. Also we have a code button behind every pt's bed, if i see a fhr decel that i cannot correct immediately with o2, repositioning, and a bolus (if the pt has fluids running), I hit the button in order not to leave the pt's side so i can continue to attempt to bring the FHR up while the staff runs into the room to assist me and call the OB doc and NICU, can i write that i hit the code button for those reasons in the chart?

(the code button only alerts OB/NICU staff)

[schack]

I am new to OB, so I am interested to see how the experienced OB nurses answer this question. I, however, let my pt's know prior to their epidural that one of the side effects can be a drop in maternal BP with a related decel in baby. I also reassure them that we take measures to correct this with positioning, O2, fluids, meds, etc. I believe that pt's should be fully informed and also it is less scary (IMO) when I start interventions post epidural. I believe that it makes my pt's more cooperative and in those moments I am focused on fixing the issue not explaining it. If I need assistance from other nurses/staff I use the call light. I would only press the maternal code button for a true code. In my hospital the code button would bring not only OB staff but also our CODE team. I certainly don't want 1/2 my ER and anesthesia staff responding for a decel... I'm pretty sure that would get my backside chewed...

[HeartsOpenWide, RN]

Yes you can tell the patient this. I do all the time. The patient has a right to know the side effects of any treatment she is getting or else it is not informed consent. And yes you should write down that you pushed the code button/call for back-up....although are you really pushing the "code" button or the "staff" button? A decel is not a "code" but does warrant pressing the "staff" button to get your co-workers in the room for back up.

[ragingmomster, BSN, MSN, RN]

I am up front and let my patient know that a common side effect of epidurals, blood pressure decreases and if it does "I will try to reverse it with fluids, position changes and meds." Informed patients are happier patients.

[newmidwifehopeful]

I agree that you should tell the patients about the risk. I think both the patient and the family are less frightened if they know what is going on and that what is happening is common and that there are things we can do to correct.

[CEG]

Your patient should not be receiving an epidural without informed consent. If she does get it without being informed of the risks (which many/most do in my experience) you should not hesitate to tell her why a decel is happening. After all, what is scarier- baby's heartrate is suddenly dropping for no reason, or the epidural has caused baby'r heartrate to drop, a known and generally reversible side effect.

We have a real issue in OB with not providing informed consent and using interventions without good reason, you can fix that in small ways.

[tewdles, RN]

I agree...the patient has a right to be informed...

You said that your charge nurse disagrees and this is actually a teachable moment...

If you are a brave, adventurous, motivated soul...do some research, and speak to your department education staff about this. You may be instrumental in improving the overall professional practice of your department!

Yes if you activate some sort of "alert" or "emergency" call system which is internal during your care, I would suggest you document it. Remember that your job in documentation is to tell the story, as concisely and clearly as you can, as to what care you provided, what actions you took, and the patient condition and response to those activities.

[babyktchr, BSN, RN]

I can't add anything to this other than I can't believe a charge nurse would tell you that. Amazing.