Question

The client is experiencing a decrease in the fetal heart tones beginning at the increment of the contraction and returning to baseline by the acme or end of each contraction. Between contractions the fetal heart tones are 130–140 beats per minute with good variability. Which action should be taken first? ? A. Prepare for delivery ? B. Perform a vaginal exam ? C. Ask the client to push with each contraction ? D. Call the doctor immediately

Short answer

Answer: B. Perform a vaginal exam

Step-by-step solution

Understand the situation

We are presented with a pregnant client whose fetal heart tones are decreasing at the beginning of each contraction and returning to baseline at the acme or end of the contraction. The fetal heart rate between contractions is within the normal range and shows good variability.

Analyze each option

Now that we understand the situation, let's analyze each option: A. Prepare for delivery - Preparing for delivery might be a possible option, but we need to make sure it is the most appropriate and priority action. Let's analyze the other options first. B. Perform a vaginal exam - Performing a vaginal exam is an appropriate step to evaluate the client's progression in labor and how the baby is moving through the birth canal. C. Ask the client to push with each contraction - Asking the client to push may not be the best first response, as it is important to assess the situation before encouraging pushing with contractions. D. Call the doctor immediately - Calling the doctor immediately should be done if there is any distress or an emergency situation. In this case, we need to evaluate the severity of the decrease in fetal heart tones.

Determine the priority action

Based on our analysis, the priority should be to assess the situation more closely before moving directly to delivery or encouraging the client to push with contractions. As such, the first action to take is: ? B. Perform a vaginal exam This will give additional information on the client's progression in labor and the baby's status in the birth canal. After performing a vaginal exam, further actions can be determined, such as calling the doctor or preparing for delivery if necessary.

Key concepts

Fetal Heart Tones Assessment

Assessing fetal heart tones is a crucial aspect of monitoring the well-being of the fetus during labor. These heart tones provide valuable insights into how the fetus is handling the stress of contractions and potential labor progression.

The baseline fetal heart rate typically ranges between 110 to 160 beats per minute (bpm), and good variability indicates a healthy fetal response to intrauterine conditions. However, when there is a decrease in the fetal heart tones beginning at the increment of the contraction, it could suggest a non-reassuring pattern that warrants further investigation. In the scenario provided, the heart rate returns to baseline by the end of the contraction, which is often a sign of head compression as the fetus descends into the birth canal.

Health care providers use electronic fetal monitoring (EFM) to assess these changes in heart rate. A periodic decrease associated with the contractions is referred to as a deceleration. Decelerations can be early, variable, or late, indicating different concerns. Early decelerations mirror the contractions and are typically not a sign of distress. The presence of good variability between the contractions, as in the scenario, suggests that immediate delivery may not be necessary but should be closely watched. Regular assessment of fetal heart tones allows practitioners to act swiftly should patterns indicate fetal distress.

Labor and Delivery Nursing

Labor and delivery nursing encompasses specialized care provided to pregnant individuals and their families throughout the labor process. It involves constant vigilance, quick decision-making, and compassionate support.

Nurses play a critical role in monitoring both maternal and fetal well-being. They keep a close eye on labor progression, including assessing contractions, dilation, fetal heart tones, and maternal vitals. Effective communication with the healthcare team and the laboring person is essential in ensuring a safe delivery process.

During labor, nurses also provide education on what to expect and how to cope with the pain and exhaustion of labor. Assistance with breathing techniques and positions for labor, as well as preparation for potential interventions, is part of their responsibility. In the scenario's context, the nurse's initial action is accurately directed towards gathering more information through a vaginal exam before deciding on further steps such as preparing for delivery or consulting the physician.

Vaginal Exam in Labor

A vaginal exam in labor is conducted to evaluate the progression of labor and the status of the cervix. It helps determine the cervical dilation, effacement, station, and presentation of the fetus. This physical examination provides essential information on how close the individual is to delivering their baby and assists in identifying any potential complications.

During the exam, a healthcare provider will gently insert two fingers into the vagina to assess the changes in the cervix. They also can determine the position of the fetus in relation to the pelvis, which is crucial for planning the course of labor management.

Important aspects to consider during a vaginal exam include:

• Sanitation and comfort: Ensuring clean hands and gentle techniques to prevent infection and minimize discomfort.
• Frequency: Limiting the number of exams to reduce the risk of introducing pathogens.
• Communication: Explaining the procedure and findings to the laboring individual to alleviate any anxiety.

In the exercise provided, performing a vaginal exam is prioritized to confirm whether the decrease in fetal heart tones correlates with specific labor milestones or indicates a potential concern that requires immediate attention or intervention.