Maternity Test Question bothering me

Jolie, BSN · Feb 17, 2009

In reality, you would be doing 3-4 things at once, administering O2, placing patient on her L side, increasing the IV rate and calling for help.

The reason I would not have chosen B is that raising the patient's legs may allow the epidural to "migrate" to a higher level, which you don't want to happen.

Not sure if that is sound reasoning. Maybe some more experienced L&D posters could she some light.

Esther2007 · Feb 17, 2009

I emailed the instructor, waiting for the two extra points.

KAYBDT6, BSN, RN · Feb 17, 2009

RE: Maternity Test Question bothering me.

From the 4 options I am very sure of option B. Because if hypotention is notice from administration of Epidural, the first initial action is to position the pt on her left side, then notify the physician and the physician right an order for administaion of oxygen. you as a nurse can not administer oxygen without an order. All the option listed are priority but the first is POSITION. Do hope i make sense with this suggestion. Thanks

Jolie, BSN · Feb 17, 2009

http://nursing.intranet.unchealthcare.org/servicelines/womens_services/labordelivery/most-commonly-used-policies-procedures-and-protocols/labor%20epidural.pdf?searchterm=suction

epidural protocol for unc hospitals specifies nursing actions for hypotension as follows:

emergency measures: 20. maternal hypotension:

•turn patient to left (preferable) or right lateral position

•increase maintenance iv rate to 200 ml/hr

•administer o2 at 8 to 10l/min. via tight non-rebreather face mask

•take bp every 2 minutes until stable

•notify physician

*•ephedrine 5mg iv push if fhr decelerations appear and/or bp decreases below 90

mmhg systolic and anesthesiologist not immediately available

note that only the final action (ephedrine) has an asteric, indicating the need for a physician order.

sikesjj · Feb 18, 2009

I would of chosse Administer O2 also, because you are going to follow your ABC's. I would put that in my reasoning along with the possibility of the epidural migrating. But we were drilled on following the ABC's, hope it helps!!!!

Jamie

suzanne4, RN · Feb 18, 2009

A wound not be the acceptable answer for this question and that is why it was marked incorrect. Same as if you had something like it on the NCLEX exam.

There is much more to be doing than having oxygen administration as your first step in this process and that is what the question wants you to think about. What are you going to be doing first? What can you do first that is going to increas the patient' blood pressure and therefore blood supply to the fetus?

You are always going to make sure that she is on her side first and foremost. Most facilities have standing orders in place in their labor and delivery areas concerning the administration of oxygen. You need to get into the habit of prioritizing what you would do first. Placing Os would not be the first thing that should come to mind, and therefore would not be considered the first response.

All of those answers weractually correct in terms of what needs to be done, but not in that order. And that is what counts.

Other thing to consider, for the time that you spent trying to get the oxygen to the patient, you could have had her on her side in much less time. No patient spends their entire time on their side with the epidural in place. This is asking what you would do in an emergency type setting.

suzanne4, RN · Feb 18, 2009

I would of chosse Administer O2 also, because you are going to follow your ABC's. I would put that in my reasoning along with the possibility of the epidural migrating. But we were drilled on following the ABC's, hope it helps!!!!
Jamie

Again, administration of O2 would not be your first response as to what to do.

How are you going to increase oxygen to the fetus as well as blood supply?

That is always turning the patient on her side, then you can follow the next steps. Remember that you now have a second soon to be born individual here and they are the priority at this time. Quickest way to improve things is to have the mother turn to her side.

You actually also see mothers ambulating in halls with an epiudural. They are not confined to bed on their side as well.

BabyLady, BSN, RN · Feb 18, 2009

I'm awaiting your answer as well.

I would have took a good hard look B but the "or" part would have thrown me, and my thinking is the "or" makes the answer wrong.

Suzanne is 100% correct about placing on the left side...that would be the first thing you would do...but then again, there is that "or" part.

So my final answer would have been A.

Just my guess :)

suzanne4, RN · Feb 18, 2009

What are you going to do first is what you should be looking at. All of those choices will be completed at one time or another, but what will you do first. What is going to be your priority and what can you get done the fastest to get an increased blood supply to that baby? That is how you need to look at things. If the mother is not already on her side, then giving her all of the oxygen in the world is not going to help that baby and that is what you are not looking at. Always much faster to do something that does not involve getting extra equipment, placing it on the patient as well as turning it on.

Not sure why you think that there is an issue with raising the patient's legs. Most definitely there is not.

And again, for those of you that are thinking about ABCs, this means getting oxygen to the baby as well. And so turning onto their side would be the priority to get the pressure up and more oxygen-saturated blood thru the maternal blood system and then to the baby. So using your idea of the ABCs, still puts turning on the side number 1, and this is what you would be looking at in any exam when you are discussing what you are going to do first.

As mentioned above, all of those choices are viable, but it is the order in which you would perform them. And for the person that mentioned you would need to call the physician first before applying oxygen: each and every labor and delivery suite is set up with standing orders and what to do in a certain situation. You consider baby first in this case. Take care of the problem with what you have available to you, and then you notify the physician. In an emergency, you can apply oxygen. Same thing that you do when a patient is experiencing chest pain; you do not leave them there and go and call the physician. There are routines that are followed.

Remember the word PRIORITY when trying to decide on an answer for any question, that is what is going to help you pass the exam.

And even look at what one of the students quoted from a book, it even states lift the patient's legs if needed.

suzanne4, RN · Feb 18, 2009

Same thing when when a non-pregnant patient is hypotensive, you can either lift the legs or tip the bed down. If they are not someplace where you have that option, such as they are on the floor someplace; the only option that you have is to raise their legs.

I most definitely would not award any points if one listed oxygen as their first answer. It is not the priority in a situation like this, but rather #2.

Esther2007 · Feb 18, 2009

Thank you so much Suzanne, I really appreciate your help. I got a 94 on the exam, and a 99 on the quiz. My concern was what the book says as oppose to what hospitals are doing. I was told from nursing 101, stick with the book. The book supported option A, which was my answer and partially supported option B. I will see my instructor tonight and briefly mention it to her in a nice way.

Thanks again!

Love this site, very helpful!