A nurse is providing teaching with an antepartum client who has a new diagnosis of genital herpes simplex virus 2 (HSV-2). Which of the following information should the nurse include?

Choice A rationale

Polyuria, an abnormally large production of urine, is not a typical adverse effect of epidural analgesia. Epidural analgesia, due to its influence on sympathetic nervous system blockade, can sometimes lead to urinary retention by inhibiting bladder detrusor muscle contraction and relaxing the urethral sphincter. Therefore, polyuria would be an unexpected finding.

Choice B rationale

A maternal temperature of 37.4° C (99.4° F) is within the normal physiological range for a laboring client. Slight elevations can occur due to the metabolic demands of labor or dehydration, but this temperature does not indicate an adverse effect directly attributable to epidural analgesia. Fever, defined as a temperature above 38° C (100.4° F), can be associated with epidural use due to thermoregulatory changes.

Choice C rationale

A fetal heart rate of 152/min is within the normal range for a term fetus, typically 110-160 beats per minute. This finding indicates a healthy fetal response and does not suggest an adverse effect of epidural analgesia. Epidural analgesia itself usually does not directly alter the fetal heart rate in a negative way if maternal hemodynamics remain stable.

Choice D rationale

Hypotension is a common adverse effect of epidural analgesia. It occurs due to sympathetic blockade, which causes vasodilation and peripheral pooling of blood, leading to decreased venous return to the heart and a subsequent drop in cardiac output and blood pressure. This reduction in blood pressure can compromise uteroplacental perfusion.

• Moderate maternal bleeding: Worsening condition. HELLP syndrome involves platelet consumption and liver dysfunction that can cause coagulopathy and bleeding risk. New or increased bleeding signals disease progression and possible disseminated intravascular coagulation (DIC).
• Client reports ringing in ears: Worsening condition. Tinnitus can be a sign of hypertensive encephalopathy or central nervous system involvement from severe preeclampsia/HELLP, indicating neurological deterioration.
• BP 180/100 mm Hg: Worsening condition. A significant increase from baseline hypertension signals uncontrolled blood pressure and heightened risk for stroke, organ damage, and progression of HELLP.
• Client reports sharp, stabbing abdominal pain: Worsening condition. This could indicate hepatic hematoma or infarction, a serious complication of HELLP syndrome due to liver injury.
• FHR 80/min with absent variability: Worsening condition. Fetal bradycardia with absent variability indicates fetal distress, often from placental insufficiency related to maternal vascular compromise.
• PT 12 seconds: Indication of improving condition. Normal prothrombin time (PT range ~11-13.5 seconds) suggests stable coagulation status, indicating no worsening coagulopathy or bleeding tendency at this moment.