QUESTION: "A pregnant client's labor is progressing, but her cervix is still only 5 cm dilated and 100% effaced. Although she appears relaxed, she is aware of labor contractions. At this time, which of the following suggestions would be most helpful for the client's husband?"
CHOICES
( X ) a.) "Keep a record of her contraction pattern."
( O ) b.) "Encourage her to rest between contractions."
( X ) c.) "Suggest that she receive an epidural anesthetic."
( X ) d.) "Have her practice rapid, shallow breathing."
RATIONALE: Because the client has had prolonged labor, the client should be encouraged to rest as much as possible. In addition, the client should be encouraged to use appropriate breathing techniques, particularly slow chest breathing. Although the husband or significant other may keep track of the client's contraction pattern, this responsibility is that of the nurse caring for the client. Suggesting that she receive an epidural anesthetic is not appropriate because the client may desire natural childbirth methods. Rapid, shallow breathing or pant:blow breathing is inappropriate for this stage of labor because it can cause possible hyperventilation and lead to dizziness. This type of breathing is more appropriate for the transition stage of labor. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Health promotion and maintenance CLIENT NEEDS SUBCATEGORY: None
