wondering about late decels

[kgh31386, BSN, MSN, RN]

I know you wanna do all of the given...position change, O2, stop the Pit., call the MD. But...priority wise, which would you pick? I know there's that whole saying of "if you had to pick 1 thing and go home, what would you pick". But what would you do first Nclex wise..stop the Pit, position, O2? Just wanna compare to what they taught me in school.

[noski]

I have not taken the nclex yet, but i have seen this Q in a practice test. Your first intervention will be to stop the Pitocin(since thats whats causing the decels) before you change position and give O2

[kgh31386, BSN, MSN, RN]

They taught me in school to change position first, and all the interventions from Saunders, ATI...etc, all say change position first.

[dblpn]

They taught me in school to change position first, and all the interventions from Saunders, ATI...etc, all say change position first.

Yeah, same here. you position the mom on her left side is what I was told.

[wannabHishands]

Are you sure it's change the position for LATE decels? I thought for placental insufficiency (late decels), the baby is not tolerating contractions well, so you administer oxygen first. I do know for sure that variable decels is cord compression, so you change position first...

[caliotter3]

I would do some further investigation and go with the best answer found. My first reaction is to stop the pit but I think that it is reposition. I would like to see what several sources say about it before I make up my mind.

[Sarah Ann Hay]

I know the first thing you do is reposition the client. However, I've never had a question with an option to stop the transfusion. I'm not sure what you'd do first. ): You could essentially do them at the same time ... just reach up and clamp the line.

[Little Panda RN, ASN, RN]

We were taught to stop the pit, start 02, reposition and then call MD, but I did an internet search and everything I read says to reposition to left side lying, O2 8-10L min, then stop the pit. Maybe someone will come along who knows exactly what to do first.

[wannabHishands]

I am almost completely totally positive about this... I have had this question in more than one source.

IF you are administering pit, and the baby is having late decels, you STOP THE PIT, then administer O2 and change position (stopping the pit being the important part, because the pit is causing them). If the HR is variable, you reposition, because the cord is compressed. If you are not giving pit, and the baby has late decels, you give O2, because the placenta is not sufficiently providing O2.

I see one trend here in the discussion, and it's a trend that I have fought hard to overcome myself... we cannot simply memorize the correct answer, we have to think it through and figure out what is really going on. If we are still wanting just one answer to this question, we'd be better off to go back and read the content about fetal HR and variability until we understand all of the possibilities.

[Sarah Ann Hay]

I looked at ATI and it gives a list of interventions but does not place them in order!

[wannabHishands]

I know that they say never to study with this philosophy, but I just hope I don't get one of these on the test... that would make it so much easier! :smackingf

[kgh31386, BSN, MSN, RN]

Even if you stop the infusion...a contraction will come right along and knock the HR down. If you turn them on the left, you increase the perfusion and take the pressure off the vessels...hence fix the perfusion problem, regardless of any contractions or pit.