A client with chronic peripheral arterial disease (PAD) asks the nurse why this disease developed. Which explanation by the nurse is most accurate?

Choice A reason:
Administering oxygen using a non-rebreather mask is a subsequent step if initial measures do not improve fetal heart rate decelerations. It can help increase the amount of oxygen available to the fetus. Oxygen administration is a supportive measure that can be used if there are signs of fetal distress. In the scenario described, where the fetal heart rate slows after the start of a contraction with the lowest rate occurring after the peak, it suggests late decelerations, which are often associated with uteroplacental insufficiency. Administering oxygen can help increase the fetal oxygen reserve and is a common intervention during labor when there are concerns about fetal well-being.

Choice B reason:
Increasing the rate of maintenance IV infusion is typically considered when there is a concern for maternal hypotension or dehydration, which may not be the immediate cause of the observed fetal heart rate pattern. Increasing the rate of an IV infusion can help improve maternal hydration and blood pressure, which in turn can enhance placental perfusion. However, this intervention is more indirect and may not provide the immediate response needed to address fetal heart rate decelerations. It is typically considered after more direct interventions, such as repositioning the mother, have been attempted.

Choice C reason:
Elevating the client's legs can help improve venous return to the heart, potentially increasing maternal cardiac output and blood flow to the placenta. While this can be beneficial, it is not the primary intervention for late decelerations. Repositioning the mother to improve uteroplacental circulation is generally the first step.
Choice D reason:
Placing the client in the lateral position is often the first action taken when late decelerations are observed. This position helps improve uteroplacental blood flow and can quickly address potential issues related to fetal oxygenation. This position helps to relieve pressure on the inferior vena cava and aorta, which can be compressed by the gravid uterus, especially in the supine position. Relieving this pressure helps to improve uteroplacental circulation and can quickly address the cause of late decelerations, which is often related to compromised blood flow to the placenta.

Choice A reason:
Duloxetine is a medication that should not be stopped abruptly due to the risk of withdrawal symptoms. Gradual tapering is recommended to minimize these symptoms. This understanding by the client indicates effective medication teaching.

Choice B reason:
The statement about the medication being safe with herbal supplements is incorrect. Patients should consult their healthcare provider before using herbal supplements with duloxetine, as there can be interactions.

Choice C reason:
The need to avoid aged cheese is associated with monoamine oxidase inhibitors (MAOIs), not duloxetine, which is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). This statement does not reflect accurate medication teaching for duloxetine.

Choice D reason:
Taking extra doses for anxiety without consulting a healthcare provider is not recommended. Duloxetine dosing should be consistent and as prescribed by a healthcare provider. This statement suggests a misunderstanding of medication management.