In the diuretic phase of renal failure, which of the following happens?

Choice A rationale:

Prostaglandins:

Mechanism of action: Prostaglandins are hormone-like substances that play a crucial role in labor initiation. They act by softening and ripening the cervix, stimulating uterine contractions, and rupturing the amniotic sac.

Types: Prostaglandins used for labor induction include:

Dinoprostone (Cervidil, Prepidil): Inserted into the vagina as a gel or pessary.

Misoprostol (Cytotec): Administered orally or vaginally.

Effectiveness: Generally effective in initiating labor within 24 hours, with success rates ranging from 60-85%.

Advantages:

Can be used when the cervix is unfavorable (not ripe).

Can be administered in a variety of ways to suit the patient's preferences.

May have a lower risk of uterine hyperstimulation compared to oxytocin.

Disadvantages:

Can cause side effects such as nausea, vomiting, diarrhea, and fever.

May increase the risk of uterine rupture, especially in women with a history of cesarean delivery.

Choice D rationale:

Amnioinfusion:

Procedure: Involves the infusion of sterile saline solution into the amniotic sac through a small catheter.

Mechanism of action: Not fully understood, but it's thought to work by:

Increasing amniotic fluid volume, which can help to stimulate contractions.

Stretching the uterine walls, which may trigger the release of prostaglandins.

Reducing pressure on the umbilical cord, which can improve fetal oxygenation.

Effectiveness: Usually used in conjunction with other induction methods, such as oxytocin or prostaglandins. Has a success rate of about 50-60% in initiating labor within 24 hours.

Advantages:

May be helpful in cases of low amniotic fluid (oligohydramnios).

Can decrease the risk of umbilical cord compression.

Disadvantages:

Requires the insertion of a catheter into the uterus, which carries a small risk of infection.

May cause discomfort for the mother.

Rationale for Choice A:

Administering oxygen via a mask or nasal cannula is the most appropriate nursing intervention in this situation. Here's a detailed explanation:

1. Addresses Hypoxia: The client's symptoms of lightheadedness, dizziness, and tingling fingers strongly suggest hyperventilation, which can lead to hypoxemia (low blood oxygen levels). Administering oxygen directly increases the concentration of oxygen in the client's bloodstream, rapidly addressing the hypoxia and its associated symptoms.
2. Promotes Calmness: Oxygen therapy can also have a calming effect, which can help to slow the client's breathing rate and further improve oxygenation. This is crucial during the transition phase of labor, as anxiety and stress can exacerbate hyperventilation.
3. Supports Fetal Oxygenation: Ensuring adequate maternal oxygenation is essential for fetal well-being. By providing oxygen to the mother, the nurse is also indirectly supporting the oxygen supply to the fetus.

Rationale for Choice B:

Telling the client to breathe at a normal rate is not an effective intervention for hyperventilation. It's often challenging for a client experiencing hyperventilation to control their breathing rate on command. This approach can also increase anxiety, potentially worsening the hyperventilation.

Rationale for Choice C:

While notifying the physician is important to keep them informed of the client's status, it's not the immediate priority in this situation. The nurse can independently initiate oxygen therapy to address the client's hypoxia and improve her condition. The physician can then be consulted for further guidance or interventions if needed.

Rationale for Choice D:

Instructing the client to breathe into her cupped hands is a technique that can sometimes help to slow breathing and increase carbon dioxide levels. However, it's not as effective as administering oxygen in addressing the underlying hypoxia and may not provide sufficient relief for the client's symptoms.