When working with a woman who has just experienced a fetal demise you should offer supportive care, give her the opportunity to grieve, and provide for a chaplain to come in if the patient wants one. You know that the Chaplain is non-denominational and can also provide comforting words.

A. Frequent monitoring of vital signs. A post-dural puncture headache (PDPH) can occur after epidural anesthesia due to leakage of cerebrospinal fluid (CSF). Monitoring vital signs, particularly blood pressure and heart rate, helps assess for hypotension, fluid balance, and overall neurological status.

B. Assisting with a blood patch procedure. An epidural blood patch is the most effective treatment for a severe post-dural puncture headache. This procedure involves injecting the patient’s own blood into the epidural space to seal the CSF leak and relieve symptoms. The nurse should prepare for the procedure and educate the patient about it.

C. Administration of oral analgesics. Oral analgesics, such as acetaminophen or ibuprofen, are used to relieve mild to moderate headache symptoms. However, they may not be fully effective for a severe PDPH and are often used as supportive therapy along with other interventions.

D. Keeping the head of bed elevated at all times. Lying flat, rather than elevating the head of the bed, is actually recommended to help reduce CSF leakage and alleviate headache symptoms. Keeping the head elevated may worsen the headache by increasing CSF pressure changes.

A. Preterm labor. Methotrexate is not used for preterm labor. Medications such as tocolytics (e.g., nifedipine, magnesium sulfate, or terbutaline) are typically used to delay labor and improve neonatal outcomes, but methotrexate does not serve this purpose.

B. Abruptio placentae. Methotrexate is not indicated for abruptio placentae, which is the premature separation of the placenta from the uterine wall. Management of abruptio placentae focuses on stabilizing the mother, monitoring fetal well-being, and delivering the baby if necessary.

C. Pre-eclampsia. Methotrexate does not treat pre-eclampsia. The management of pre-eclampsia includes antihypertensive medications, magnesium sulfate for seizure prevention, and delivery of the baby when indicated.

D. Unruptured ectopic pregnancy. Methotrexate is the first-line treatment for an unruptured ectopic pregnancy. It works by inhibiting rapidly dividing trophoblastic cells, stopping the growth of the ectopic pregnancy while preserving the fallopian tube. It is only used in stable patients with small, unruptured ectopic pregnancies and no signs of internal bleeding.