An injection of local anesthetic drug into epidural space, which blocks transmission of pain impulses to brain and is given when cervix is in active labor at least 4cm dilated is called what?

A. Wipe from the back to front when performing perineal hygiene: The correct method for perineal hygiene is to wipe front to back to reduce the risk of introducing bacteria into the vaginal area, especially in a client with PROM who is at risk for infection.

B. Keep a daily record of fetal kick counts: Monitoring fetal kick counts helps assess fetal well-being, particularly in a high-risk pregnancy like PROM at 26 weeks. It helps detect potential fetal distress early.

C. Avoid bubble bath solution when taking a tub bath: While avoiding bubble bath may help prevent irritation or infection, tub baths should be avoided entirely in cases of PROM to reduce the risk of ascending infection.

D. Use a condom with sexual intercourse. Sexual intercourse is contraindicated in clients with PROM due to the risk of infection.

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.