During the oliguric phase of acute renal failure, which of the following occurs?

Choice C rationale:

It is a misconception that fetal movement decreases as delivery approaches. While the nature of the movements may change— becoming less like kicks and more like rolls or twists due to less space in the uterus—the frequency of movements should remain consistent. In fact, increased fetal movement can be a sign of labor approaching. Therefore, a pregnant client who believes that fetal movements will decrease closer to delivery needs further instruction to ensure they are aware of this important health indicator.

Here's a detailed explanation of why the other choices are correct:

Choice A: This statement is correct. Fetal kick counts can be performed at home, providing a convenient and comfortable way to monitor fetal well-being.

Choice B: This statement is also correct. A decrease in fetal movement, defined as less than 3 kicks in an hour, is a potential concern and warrants contacting a healthcare provider for further evaluation.

Choice D: This statement is accurate as well. Daily fetal kick counts are generally recommended to establish a baseline of the baby's usual activity pattern and to detect any significant changes that might indicate a problem.

Rationale for Choice A:

Encouraging the woman to rest between contractions can promote relaxation and help conserve energy, but it does not directly address the mechanisms of pain transmission as explained by the gate-control theory. Rest can have indirect benefits for pain management, but it does not directly interfere with pain signals in the same way that massage does.

Rationale for Choice B:

Administering prescribed medication can effectively block pain signals, but it does not rely on the principles of the gatecontrol theory. Medications typically work through pharmacological mechanisms that target pain receptors or neurotransmitters, rather than by competing with pain signals at the spinal cord level.

Rationale for Choice D:

Changing the woman's position can sometimes alleviate discomfort by shifting pressure or encouraging fetal movement, but it does not directly apply the gate-control theory either. Position changes can offer some physical relief, but they do not directly modulate the transmission of pain signals.

Rationale for Choice C:

Massaging the woman's back directly aligns with the gate-control theory of pain management. This theory proposes that nonpainful sensory input can effectively compete with pain signals, preventing them from reaching the brain. The following mechanisms explain how massage applies this theory:

Stimulation of non-painful nerve fibers: Massage activates large-diameter nerve fibers that transmit touch, pressure, and vibration sensations. These signals travel faster than pain signals and can effectively "close the gate" at the spinal cord, preventing pain signals from ascending to the brain.

Release of endorphins: Massage can stimulate the release of endorphins, the body's natural pain relievers. Endorphins bind to opioid receptors in the brain and spinal cord, reducing the perception of pain.

Reduction of muscle tension: Labor pain often involves muscle tension and spasms. Massage can help relax tense muscles, which can indirectly reduce pain by decreasing muscle ischemia and the release of pain-provoking substances.

Promotion of relaxation and distraction: Massage can induce a state of relaxation and provide a distraction from pain. This psychological effect can further contribute to pain relief by reducing anxiety and focusing attention on pleasant sensations.

Conclusion:

Massage offers a non-pharmacological, evidence-based approach to pain management that directly aligns with the gate-control theory. By stimulating non-painful sensory input, promoting relaxation, and releasing endorphins, massage effectively interrupts pain signals and provides significant relief for women in labor.