Question

The client is receiving Pitocin (oxytocin) for augmentation of labor. Which finding would necessitate the need to discontinue the oxytocin? ? A. The client’s contractions are every three minutes, lasting 60 seconds. ? B. The client complains of a desire to push with contractions. ? C. The client’s fetal heart tones are 110 beats per minute prior to contractions and 80 beats per minute at the end of the contraction for the last twenty minutes. ? D. The client complains of nausea and vomiting with contractions.

Short answer

Answer: The situation that necessitates discontinuing oxytocin for a client in labor is when the client's fetal heart tones are 110 beats per minute prior to contractions and drop to 80 beats per minute at the end of the contraction for the last twenty minutes.

Step-by-step solution

Identify the normal effects of oxytocin during labor.

Oxytocin is a hormone used to induce or augment labor by stimulating uterine contractions. Its normal effects include more frequent and stronger contractions, and the client might feel more pain during labor.

Evaluate each scenario's impact on the client and the baby.

Now, let's analyze each option: A. Contractions every three minutes, lasting 60 seconds: This is a typical contraction pattern during active labor. There is no need to discontinue the oxytocin. B. Client complains of a desire to push with contractions: This could indicate that the client is in the second stage of labor, and the baby is ready to be delivered. There is no need to discontinue the oxytocin. C. Fetal heart tones are 110 beats per minute prior to contractions and 80 beats per minute at the end of the contraction for the last twenty minutes: This represents a significant drop in fetal heart rate during contractions, which may indicate fetal distress. This situation warrants discontinuation of oxytocin and further evaluation. D. Client complains of nausea and vomiting with contractions: Nausea and vomiting could be a normal side effect of labor, as contractions may cause discomfort and gastrointestinal symptoms. There is no need to discontinue the oxytocin.

Choose the scenario that necessitates discontinuing oxytocin.

Based on our evaluation of each scenario, the option that necessitates discontinuing oxytocin is: C. The client’s fetal heart tones are 110 beats per minute prior to contractions and 80 beats per minute at the end of the contraction for the last twenty minutes.

Key concepts

Fetal Distress

Understanding fetal distress is crucial when considering the health of the baby during labor. It is a term used to describe signs before or during childbirth indicating that the fetus is not well. This condition can happen due to various reasons such as insufficient oxygen supply or infection.

During labor, constant monitoring of the fetal heart rate is essential in identifying distress. A normal fetal heart rate typically ranges between 110 and 160 beats per minute. Significant deviations from this range might suggest fetal distress. Factors that could cause this condition include problems with the placenta, umbilical cord issues, or prolonged labor.

Fetal heart rate monitoring helps in detecting any potential distress. For instance, a decrease in the fetal heart rate below the expected baseline during or after a contraction, known as a 'deceleration,' can be an indicator of distress. It's warranted to take immediate action, such as providing maternal oxygen, changing the mother’s position, or if severe enough, considering an emergency delivery.

Induction of Labor

Inducing labor is the process of stimulating contractions before they begin naturally, to achieve a vaginal birth. Induction of labor might be recommended for various medical reasons, such as the baby being overdue or the mother having a condition that could risk her health or the baby's, such as high blood pressure or diabetes.

One commonly used method for induction is administering synthetic oxytocin, a hormone that naturally occurs in the body to stimulate uterine contractions. The closely related medication, Pitocin, is used to either start labor or augment (intensify) it if it's progressing slowly. The goal is to mimic natural contractions and advance labor in a controlled manner.

Dosage requires careful management, typically starting low and increasing gradually to achieve the desired frequency and strength of contractions. Excessive stimulation, however, can lead to strong, frequent contractions that may cause fetal distress or other complications such as uterine rupture.

Uterine Contractions

During childbirth, uterine contractions play a critical role in helping to deliver the baby. These contractions help to dilate the cervix and move the baby down the birth canal. Not all contractions mean labor is imminent; 'Braxton Hicks' contractions may occur as a sort of rehearsal in the weeks leading up to labor.

However, true labor contractions are regular, become more frequent and intense over time, and are typically accompanied by cervical dilation. The pattern of these contractions can indicate how labor is progressing and whether interventions such as oxytocin might be necessary.

The administration of oxytocin aims to either initiate or reinforce these contractions, making them strong enough to be effective in progressing labor but not so strong as to compromise the baby's well-being or the mother's health. Monitoring both the frequency and quality of contractions is an important part of managing a safe delivery.

Fetal Heart Rate Monitoring

Fetal heart rate monitoring is a method used to check the rate and rhythm of the fetal heartbeat. It is an essential aspect of prenatal care during labor, as it provides immediate information about the baby's well-being and how well they are tolerating the birthing process.

Electronic fetal monitoring (EFM) is the most common way to monitor fetal heart rate. It can be done continuously or at intervals. Continuous monitoring is especially important when labor is induced or augmented with oxytocin, since the associated increased strength and frequency of contractions can affect the baby's heart rate.

A normal fetal heart rate is a reassuring sign, but if abnormalities are noted — such as a consistently low heart rate after a contraction (as seen in the exercise with the rate dropping to 80 beats per minute) — it may signal distress, indicating the need to adjust the labor management, and in some cases, proceed to rapid delivery of the baby.