A nurse is caring for a client who is experiencing severe pain during active labor.
Which of the following medications should the nurse plan to administer and document in the client's medical record?

Choice A rationale

Polyuria, an abnormally large production of urine, is not a typical adverse effect of epidural analgesia. Epidural analgesia, due to its influence on sympathetic nervous system blockade, can sometimes lead to urinary retention by inhibiting bladder detrusor muscle contraction and relaxing the urethral sphincter. Therefore, polyuria would be an unexpected finding.

Choice B rationale

A maternal temperature of 37.4° C (99.4° F) is within the normal physiological range for a laboring client. Slight elevations can occur due to the metabolic demands of labor or dehydration, but this temperature does not indicate an adverse effect directly attributable to epidural analgesia. Fever, defined as a temperature above 38° C (100.4° F), can be associated with epidural use due to thermoregulatory changes.

Choice C rationale

A fetal heart rate of 152/min is within the normal range for a term fetus, typically 110-160 beats per minute. This finding indicates a healthy fetal response and does not suggest an adverse effect of epidural analgesia. Epidural analgesia itself usually does not directly alter the fetal heart rate in a negative way if maternal hemodynamics remain stable.

Choice D rationale

Hypotension is a common adverse effect of epidural analgesia. It occurs due to sympathetic blockade, which causes vasodilation and peripheral pooling of blood, leading to decreased venous return to the heart and a subsequent drop in cardiac output and blood pressure. This reduction in blood pressure can compromise uteroplacental perfusion.

Choice A rationale

Applying ice packs aligns with Western medical practices for reducing swelling and pain. However, traditional yin and yang beliefs often emphasize warmth during the postpartum period to restore a perceived loss of "hot" energy after childbirth. Cold applications could be seen as counterproductive to this balance.

Choice B rationale

Maintaining a cool environment would contradict the traditional belief in maintaining warmth for the postpartum client. In many cultures, a "hot-cold" theory dictates that the postpartum period is a "cold" state, requiring warmth to restore balance and prevent illness. A cool room would be perceived as harmful.

Choice C rationale

Providing a warm beverage aligns with traditional yin and yang postpartum care. Childbirth is often seen as a significant loss of "yang" energy (warmth, activity). Consuming warm foods and beverages helps to replenish this energy, promoting restoration of balance and preventing "cold" illnesses according to this belief system.

Choice D rationale

Showering twice daily, especially with cool water, might conflict with traditional postpartum practices that often restrict bathing or emphasize warm baths. The concern is often about preventing "cold" from entering the body and disrupting the balance, as well as conserving energy during a vulnerable period.