A nurse in an antepartum unit is caring for a client.

Exhibits

For each potential assessment finding, click to specify if the finding is consistent with chorioamnionitis or preeclampsia. Each finding may support more than one disease process.

A. Administer oxygen at 10 L/min via nonrebreather face mask. The fetal heart rate (FHR) is 168/min with minimal variability, which indicates potential fetal distress or hypoxia. Providing oxygen can improve fetal oxygenation.

B. Request a prescription for hydralazine. Hydralazine is used for severe hypertension in pregnancy (BP ≥160/110 mm Hg). The client’s BP is 132/84 mm Hg, which does not indicate a need for antihypertensive medication at this time.

C. Initiate a bolus of IV fluid. IV fluid bolus can improve placental perfusion, increase maternal blood pressure (if hypotension is a concern), and correct fetal heart rate abnormalities. This is especially important with minimal variability.

D. Assist the client to the left lateral position. Repositioning to the left lateral position improves uteroplacental blood flow and may help correct FHR abnormalities.

E. Request a prescription for oxytocin. Oxytocin is used to augment labor. However, the priority here is managing fetal distress, not increasing contractions. Oxytocin may worsen fetal distress, so it is not appropriate at this time.

F. Notify the provider of the client's condition. The combination of tachycardia (FHR 168/min), minimal variability, and meconium-stained fluid indicates possible fetal distress. The provider must be notified immediately to determine further interventions.

G. Prepare to administer an amnioinfusion. Meconium-stained fluid increases the risk of meconium aspiration syndrome. An amnioinfusion (infusion of sterile fluid into the amniotic sac via an intrauterine catheter) can help dilute thick meconium and improve fetal well-being.

A. Keep the urinary bag at bladder level when ambulating. This is incorrect because the collection bag should always be kept below the bladder level to prevent backflow of urine, which can increase the risk of infection.
B. Loop the tubing so that it is lower than the collection bag. This is incorrect because kinking or looping the tubing can obstruct urine flow, leading to stasis and increasing the risk of bacterial growth and infection.
C. Obtain urinary samples by disconnecting the tubing connections. This is incorrect because disconnecting the system increases the risk of introducing bacteria. A sample should be obtained from the designated port using aseptic technique.
D. Secure the catheter to the client's thigh. This is correct because securing the catheter reduces movement and prevents urethral trauma, which lowers the risk of infection.