Which of the following actions should a nurse take for a client receiving epidural anesthesia who is hypotensive with decreased placental perfusion?

Choice A reason: Administering 20 mL per feeding is not universally appropriate, as gavage feeding volumes depend on the newborn’s weight, gestational age, and medical condition. Standardized volumes risk over- or underfeeding, potentially causing gastric distress or inadequate nutrition. Neonatal physiology requires individualized feeding plans to support digestion and growth, guided by medical prescriptions and clinical assessment.

Choice B reason: Nonnutritive sucking, such as on a pacifier, supports neurological development and soothes newborns during gavage feeding. It stimulates the suck-swallow reflex, enhancing gastrointestinal motility and reducing feeding intolerance. Scientifically, this practice promotes oral motor skills, aiding transition to oral feeding, and provides comfort, which is critical for neonatal stress reduction and developmental progress.

Choice C reason: Placing a newborn in a supine position after gavage feeding increases the risk of aspiration, as milk may reflux into the airway. Neonatal physiology favors a side-lying or prone position to facilitate gastric emptying and reduce regurgitation. This position supports safer digestion and minimizes respiratory complications, aligning with evidence-based neonatal care practices for gavage-fed infants.

Choice D reason: Cluster feedings mimic natural breastfeeding patterns, supporting neonatal nutritional needs and growth. Newborns often feed in clusters to meet caloric demands, stabilize blood glucose, and promote weight gain. This practice aligns with neonatal physiology, as the stomach’s small capacity benefits from frequent, smaller feedings, enhancing digestion and nutrient absorption in gavage-fed infants.

Choice A reason: Elevating the client’s legs does not address late decelerations, which indicate uteroplacental insufficiency. This position may reduce venous return, worsening maternal cardiac output and placental perfusion. Late decelerations require interventions to improve fetal oxygenation, such as repositioning or oxygen, not leg elevation, which is irrelevant to fetal distress.

Choice B reason: Administering lactated Ringer’s via IV bolus addresses maternal hypotension but is not the first intervention for late decelerations. Positioning improves placental perfusion immediately, while fluids take longer to act. Late decelerations reflect fetal hypoxia from reduced uteroplacental blood flow, requiring urgent repositioning to optimize circulation before secondary measures like fluids.

Choice C reason: Preparing for cesarean birth is not the first intervention for late decelerations, as intrauterine resuscitation (e.g., lateral positioning) may resolve fetal hypoxia. Cesarean is considered if decelerations persist despite interventions. Immediate surgical preparation delays reversible measures, risking unnecessary maternal morbidity while bypassing simpler methods to restore fetal oxygenation.

Choice D reason: Placing the client in a lateral position is the first intervention for late decelerations, as it relieves uterine pressure on the inferior vena cava, improving maternal cardiac output and placental perfusion. This corrects fetal hypoxia by enhancing uteroplacental blood flow, addressing the physiological cause of decelerations, per obstetric emergency protocols.