A nurse is caring for a 26-year-old gravida 2 para 1 client in the labor and delivery unit.

Exhibits

Click to indicate which interventions the nurse would include in the plan of care to support the expected outcomes of adequate epidural anesthesia on the mother and the fetus. Each column must have at least one response selected.

Assisting with pushing efforts:

• Goal: Support Epidural Anesthesia for Mother
• Reason: Epidural anesthesia can diminish the mother's ability to feel the urge to push during labor. Assisting with pushing efforts helps ensure effective delivery and supports the mother's ability to participate actively in the birthing process.

Administering bolus fluids:

• Goal: Support Epidural Anesthesia for Mother
• Reason: Administering bolus fluids can help prevent hypotension, a common side effect of epidural anesthesia. Ensuring adequate fluid volume maintains blood pressure and supports overall maternal hemodynamic stability.

Monitoring blood pressure:

• Goal: Support Epidural Anesthesia for Mother and Fetus
• Reason: Continuous monitoring of blood pressure is essential to detect and manage hypotension, ensuring both maternal and fetal well-being. It helps maintain adequate blood flow to the uterus and placenta, optimizing fetal perfusion.

Administering IV fluids:

• Goal: Support Epidural Anesthesia for Mother
• Reason: Administering IV fluids helps maintain hydration and blood pressure, counteracting the potential hypotensive effects of epidural anesthesia. It supports the mother's hemodynamic stability during labor.

Side positioning:

• Goal: Support Epidural Anesthesia for Mother and Fetus
• Reason: Side positioning optimizes uteroplacental blood flow and reduces the risk of aortocaval compression by the gravid uterus. It ensures better fetal perfusion and maternal comfort while receiving epidural anesthesia.

Rationale for correct answers

Neglect: The client’s condition and living situation indicate neglect. The client is frail, has poor hygiene, unkempt hair, dry skin, and visible pressure injuries. The daughter, who is the primary caregiver, admits to being overwhelmed and neglecting the client’s needs, such as hygiene and repositioning. Neglect is defined as the failure to provide necessary care, assistance, and supervision to a dependent individual, leading to harm or potential harm.

Adult Protective Services: As a mandated reporter, the nurse must report the signs of elder mistreatment to Adult Protective Services (APS). APS is responsible for investigating reports of abuse, neglect, and exploitation of elderly or disabled adults. Reporting to APS ensures that the client receives the necessary intervention and support to address the neglect and improve her quality of life.

Rationale for incorrect answers

Abandonment: Abandonment refers to deserting an elderly person, leaving them without the necessary care and support. In this case, the client has not been deserted; her daughter is present and attempting to provide care, although she is overwhelmed and neglectful. Therefore, abandonment is not the correct answer.

Physical abuse: Physical abuse involves the intentional use of physical force that results in bodily injury, pain, or impairment. There is no evidence of physical abuse in this case. The client’s condition is due to neglect, not physical harm inflicted by another person.

Self-neglect: Self-neglect occurs when an individual fails to meet their own basic needs, such as personal hygiene, nutrition, or medical care. In this scenario, the client is dependent on her daughter for care and unable to provide for herself due to limited mobility. The neglect is not self-imposed but rather due to the caregiver's inability to meet her needs.