A nurse is caring for a client on the labor and delivery unit.

Exhibits

Complete the following sentence by using the lists of options.

The client is at highest risk for developing

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as evidenced by the client's

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.

Given:

Desired dose: Digoxin 0.25 mg PO daily

Available concentration: Digoxin 500 mcg/10 mL

To find:

Volume to administer (in mL)

Step 1: Convert desired dose to micrograms

We know that 1 milligram (mg) is equal to 1000 micrograms (mcg). Therefore, to convert the desired dose from mg to mcg, we multiply by 1000:

Desired dose (mcg) = Desired dose (mg)x 1000

Desired dose (mcg) = 0.25 mg x 1000 = 250 mcg

Step 2: Set up the proportion

We can use the following proportion to solve the problem:

(Desired dose) / (Available concentration) = Volume to administer

Step 3: Substitute the values

Plugging in the given values, we get:

(250 mcg) / (500 mcg/10 mL) = Volume to administer

Step 4: Simplify

To simplify, we can invert the denominator and multiply:

(250 mcg) x (10 mL / 500 mcg) = Volume to administer

The "mcg" units cancel out, leaving us with:

(250 x 10 mL) / 500 = Volume to administer

Step 5: Calculate

Performing the multiplication and division, we get:

2500/ 500 = Volume to administer

5 mL = Volume to administer

A) Uterine contractions:
While uterine contractions cause significant pain and discomfort during labor, particularly in the first and early second stages, by the time the client reaches the second stage of labor, the cervix is fully dilated, and the main cause of pain and pressure is no longer from the contractions themselves. Instead, the pain and pressure described in the second stage are primarily due to the fetal head descending through the birth canal, applying pressure to the perineum.

B) The fetal head applying pressure:
The pain and pressure reported in the second stage of labor are primarily due to the fetal head descending into and through the birth canal, putting pressure on the cervix, vagina, perineum, and pelvic floor. This pressure is a major source of discomfort in the second stage, as the fetal head stretches the tissues of the perineum, which is essential for facilitating birth. The sensation of pressure on the pelvic floor is often described by clients during this stage.

C) Nerve stimulation:
Nerve stimulation occurs during labor as a result of uterine contractions and the fetal descent, which can cause radiating pain to the lower back, thighs, and pelvic region. However, the specific pain and pressure in the pelvis and perineum described by the client are more directly related to the fetal head applying pressure, rather than generalized nerve stimulation. Nerve stimulation may contribute to pain but is not the primary cause of the pelvic and perineal pressure at this stage.

D) Cervical dilation:
Cervical dilation occurs in the earlier stages of labor (latent and active phases), and while it contributes to pain during these stages, by the second stage, the cervix should be fully dilated (10 cm). The pain and pressure that the client is feeling in the second stage are less about cervical dilation and more about the descent of the fetal head through the birth canal and its pressure on the perineum and pelvic floor.