A nurse is assisting in the care of a client in an intrapartum unit.

Exhibits

Which of the following actions should the nurse take next?

Select all that apply.

A. Fetal heart tones 98/min. A fetal heart rate below 110 bpm indicates fetal bradycardia, which can signal distress and compromised oxygenation. A sudden gush of fluid suggests ruptured membranes, increasing the risk of umbilical cord prolapse, which can further restrict blood flow to the fetus. Immediate interventions, such as repositioning the client and preparing for emergency delivery, may be necessary. Fetal bradycardia is a critical finding that requires urgent medical attention.
B. Foul-smelling vaginal discharge. A foul odor may indicate an intra-amniotic infection such as chorioamnionitis, which requires antibiotic treatment. Infection can increase the risk of preterm labor and fetal complications. However, infection progresses over time, whereas fetal bradycardia is an immediate threat. Therefore, while infection management is important, stabilizing the fetus is the higher priority.
C. Amniotic fluid with meconium noted. The presence of meconium-stained amniotic fluid can indicate fetal distress due to hypoxia. Meconium aspiration syndrome is a concern, as it can cause respiratory complications after birth. While this requires careful monitoring and possible neonatal resuscitation at delivery, fetal bradycardia indicates an immediate oxygenation issue that must be addressed first.
D. Maternal temperature 38.3°C (101°F). A maternal fever suggests infection, which can lead to maternal and fetal complications if untreated. Infections like chorioamnionitis can cause preterm labor, fetal tachycardia, and neonatal sepsis. However, an abnormal fetal heart rate, especially bradycardia, is the most urgent concern, as it may indicate immediate fetal distress requiring emergency intervention.

A. Right lateral. Placing a newborn in a lateral (side-lying) position increases the risk of rolling into a prone position, which is associated with sudden infant death syndrome (SIDS). Side-lying positions are not recommended for unsupervised sleep.
B. Supine. The safest sleeping position for a newborn is on the back (supine), as recommended by the American Academy of Pediatrics (AAP). This reduces the risk of SIDS by keeping the airway open and preventing rebreathing of carbon dioxide, which can occur if the infant sleeps face-down.
C. Prone. Placing a newborn in a prone (stomach-down) position significantly increases the risk of SIDS. This position can lead to airway obstruction and impaired gas exchange, making it unsafe for unsupervised sleep. Prone positioning should only be used during supervised tummy time while the infant is awake.
D. Left lateral. Like the right lateral position, the left lateral position is not recommended for sleep because the newborn can easily roll onto their stomach. The safest way to reduce SIDS risk is to always place the baby on their back for every sleep, including naps and nighttime.