A laboring patient reports to the nurse that "I think my water just broke!" The first action the nurse should take is:

A. Explain to the client what is happening. While it's important to keep the client informed, the immediate priority is relieving pressure on the cord, which can lead to fetal hypoxia.

B. Prepare the client for an emergency cesarean birth. While preparing for a cesarean is important, it is not the first priority. Relieving pressure on the umbilical cord is the most immediate action.

C. Place the client in a knee-chest or Trendelenburg position. This position helps to reduce pressure on the umbilical cord and improve blood flow to the fetus.

D. Cover the cord with a sterile, moist saline dressing. Although this is important to protect the exposed cord, it is not the first action. The priority is to reduce the pressure on the cord by repositioning the client.

Potential Complication:

Variable Fetal Heart Rate Decelerations: Variable decelerations are typically associated with cord compression, which may occur during labor, especially with oligohydramnios (low amniotic fluid). The fetal heart rate drops to 100 bpm with contractions but recovers within 30 seconds, fitting the description of variable decelerations. Since amniotic fluid cushions the umbilical cord, a reduction in fluid can increase the likelihood of cord compression.

Actions to Take:

1. Turn client to left side: Repositioning the client to the left lateral position can relieve pressure on the umbilical cord, improve blood flow to the placenta, and reduce the occurrence of variable decelerations.
2. Initiate amnioinfusion: An amnioinfusion is a procedure where a sterile fluid is introduced into the uterus to increase the amount of amniotic fluid, reducing cord compression and improving fetal oxygenation. This can help alleviate variable decelerations caused by oligohydramnios.

Parameters to Monitor:

1. Fetal Heart Rate Baseline: Monitoring the fetal heart rate baseline is essential to assess if the decelerations are improving after interventions, ensuring the fetus is not in distress and maintaining an appropriate heart rate (120–160 bpm).
2. Uterine Contraction Frequency: Monitoring the frequency of contractions is important, especially if an amnioinfusion is performed, to ensure contractions are not becoming too frequent or too intense, which could further compromise fetal oxygenation and lead to distress.