A nurse is providing teaching to the parent of a newborn who is 1 day old and has a prescription for gavage feeding.
Which of the following information should the nurse include in the teaching?

Choice A rationale

The primary goal of epidural analgesia is to provide effective pain relief while allowing the client to maintain some sensation, particularly pressure, which indicates the epidural is blocking nociceptive pain signals effectively without completely eliminating proprioceptive awareness. This selective blockade allows the client to feel contractions, facilitating pushing efforts, while minimizing pain perception by blocking transmission of pain impulses via spinal nerves.

Choice B rationale

Bladder distention is a common side effect of epidural analgesia, resulting from the blockade of parasympathetic nerve fibers innervating the bladder, which can impair the micturition reflex. While it indicates the epidural's systemic effect, it is an adverse effect requiring intervention, such as catheterization, rather than a direct indicator of effective pain management.

Choice C rationale

A decrease in systolic blood pressure by 20 mm Hg, or more, is a common adverse effect of epidural analgesia, caused by sympathetic blockade, leading to vasodilation and subsequent peripheral pooling of blood. While it demonstrates the systemic absorption and action of the anesthetic, it signifies a complication requiring management, not an indicator of effective pain relief for labor.

Choice D rationale

Inability to move legs or feet suggests a dense motor blockade, which can occur with epidural analgesia but is not the desired outcome for labor. While a degree of motor weakness may be present, complete motor paralysis can hinder effective pushing during the second stage of labor and is usually avoided to allow for maternal participation in the birth process.

Choice A rationale

Late decelerations indicate uteroplacental insufficiency, meaning reduced blood flow and oxygen to the fetus. Placing the client in a lateral position (left or right side) can alleviate pressure on the vena cava, improving venous return to the heart, thus increasing cardiac output and uteroplacental perfusion. This is the least invasive initial intervention.

Choice B rationale

While intravenous fluid administration may be indicated in some cases to improve maternal hydration and placental perfusion, repositioning the client is a more immediate and less invasive intervention to address uteroplacental insufficiency by optimizing maternal circulation and oxygen delivery to the fetus.

Choice C rationale

Preparing for a cesarean birth is a significant intervention reserved for persistent or severe fetal distress that does not respond to less invasive measures. Although late decelerations are concerning, immediate surgical intervention is not the first step without attempting to optimize fetal well-being through maternal repositioning.

Choice D rationale

Elevating the client's legs might slightly increase venous return, but it is not the primary intervention for late decelerations. The lateral position is more effective in relieving aortocaval compression, directly addressing the underlying issue of reduced placental blood flow, and is the established first-line intervention.