A primigravida at 41 weeks gestation is in early labor and requests epidural anesthesia for pain management. Which nursing intervention should be implemented first before epidural placement?

Administer a fluid bolus of 500-1000 mL lactated Ringer's solution immediately before epidural placement to prevent maternal hypotension.

Epidural anesthesia causes sympathetic blockade, leading to vasodilation and relative hypovolemia. Fluid preload expands intravascular volume, maintaining cardiac output and uteroplacental perfusion.

• Ensure informed consent is obtained prior to the procedure, but fluid administration is the immediate physiological priority.
• Position the patient in a sitting or lateral position for epidural placement, then maintain left uterine displacement post-procedure.
• Monitor maternal blood pressure every 5 minutes for the first 15 minutes after placement and continuously assess fetal heart rate.
• Have vasopressors (e.g., ephedrine or phenylephrine) readily available to treat hypotension if it occurs despite fluid preload.