# A primigravida at 40 weeks gestation is receiving epidural anesthesia during active labor. Which assessment finding would require the nurse's immediate intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543012 > language: ko > subject: Maternal Newborn Health ## 문제 A primigravida at 40 weeks gestation is receiving epidural anesthesia during active labor. Which assessment finding would require the nurse's immediate intervention? ## 보기 1. Fetal heart rate of 140 beats per minute with moderate variability 2. Maternal blood pressure of 88/50 mmHg with complaints of nausea and dizziness **✔ 정답** 3. Contractions occurring every 3 minutes lasting 60 seconds 4. Maternal temperature of 99.2°F (37.3°C) **정답: 2** ## 해설 Maternal hypotension (88/50 mmHg with nausea and dizziness) is a critical complication of epidural anesthesia requiring immediate intervention to prevent fetal compromise. Other findings are within normal limits for active labor. ## 심화 해설 Understanding the Clinical Scenario The scenario describes a common intrapartum intervention: epidural anesthesia for a primigravida at term. While epidural analgesia provides effective pain relief, it induces significant hemodynamic changes due to the sympathetic blockade caused by the local anesthetic. The blockade leads to vasodilation in the lower extremities and splanchnic bed, pooling blood away from the central circulation. This results in decreased systemic vascular resistance (SVR) and a subsequent drop in cardiac preload and blood pressure [1]. The nurse's immediate concern is recognizing when these expected physiological changes become pathological, compromising maternal and fetal well-being. Analysis of the Correct Answer A maternal blood pressure of 88/50 mmHg with complaints of nausea and dizziness requires immediate intervention. This blood pressure reading represents significant hypotension, a direct and common consequence of the sympathetic blockade from epidural anesthesia [1]. The nausea and dizziness are classic clinical manifestations of cerebral hypoperfusion resulting from the drop in blood pressure. More critically, maternal hypotension directly threatens the fetus by reducing uteroplacental perfusion pressure. If uterine blood flow falls below a critical threshold, it leads to fetal hypoxia, manifested as late decelerations or fetal bradycardia. The immediate nursing interventions include turning the patient to a left lateral position to relieve aortocaval compression, increasing the rate of intravenous fluid administration, administering oxygen via a non-rebreather mask, and notifying the anesthesia provider for potential administration of a vasopressor like ephedrine or phenylephrine, which are used to counteract the vasodilation [1]. Why the Other Options Are Not the Priority - **Option 1:** A fetal heart rate of 140 beats per minute with moderate variability is a reassuring sign. This baseline rate is within the normal range (110-160 bpm), and moderate variability indicates an intact and well-oxygenated fetal central nervous system. This finding requires no intervention beyond continued monitoring. - **Option 3:** Contractions occurring every 3 minutes lasting 60 seconds describe a normal, adequate contraction pattern for active labor. This frequency and duration allow for sufficient uterine relaxation between contractions to facilitate fetal oxygenation. This is an expected finding and does not signal a complication. - **Option 4:** A maternal temperature of 99.2°F (37.3°C) is a low-grade elevation. While epidural anesthesia is associated with a gradual rise in maternal temperature over time due to altered thermoregulation and increased metabolic expenditure, this single reading is only slightly above normal and does not constitute an emergency. It would warrant continued monitoring for signs of infection but is not the immediate priority compared to symptomatic hypotension.References (research sources) - [1]Noninvasive Hemodynamic Assessment with Impedance Cardiography During Spinal and Epidural Anesthesia in Obstetrics.Research articleCzyżewski Ł, Juda M, Teliga-Czajkowska J, Wyzgał J, Sierdziński J, Silczuk A, Dudziński Ł. (2025) · DOI: 10.3390/jcm15010074 ## 임상 시나리오 Clinical Management of Epidural-Induced Hypotension A primigravida at term receiving epidural anesthesia develops hypotension (BP 88/50 mmHg) with nausea and dizziness. This represents a **sympathetic blockade emergency** requiring immediate, systematic intervention to restore maternal hemodynamics and fetal oxygenation. Immediate Nursing Actions - **Reposition:** Turn patient to a full left lateral position to displace the uterus off the vena cava, enhancing venous return and cardiac output. - **Administer IV Fluid Bolus:** Rapidly infuse 500-1000 mL of non-dextrose crystalloid (e.g., Lactated Ringer's) as ordered to expand intravascular volume. - **Increase IV Rate:** Maximize the primary maintenance IV line rate until a bolus is initiated. - **Notify Provider:** Immediately inform the anesthesia provider and obstetrician of the hypotension and associated symptoms. Pharmacologic Intervention - **Ephedrine:** Administer IV ephedrine 5-10 mg as ordered, the first-line vasopressor in obstetrics due to its combined alpha and beta-adrenergic effects that preserve uterine blood flow. - **Phenylephrine:** If ephedrine is ineffective or contraindicated, phenylephrine may be used as a pure alpha-agonist alternative. - **Oxygen Therapy:** Apply a non-rebreather mask at 10-15 L/min to maximize maternal oxygen delivery and fetal oxygenation while hypotension is corrected. Continuous Fetal Monitoring - **Assess FHR Tracing:** Observe for late decelerations, bradycardia, or minimal variability, which indicate fetal hypoxia from reduced uteroplacental perfusion. - **Document Response:** Record maternal BP every 2-3 minutes and FHR patterns until stabilization, noting the resolution of nausea and dizziness. - **Prepare for Emergency:** If fetal distress persists despite maternal resuscitation, prepare for possible urgent cesarean delivery. **Key Principle:** The goal is to restore a systolic BP above 100 mmHg and alleviate symptoms within minutes. Left uterine displacement is the single most effective non-pharmacologic intervention and should never be delayed. ## 핵심 개념 - **Epidural Anesthesia** — A regional anesthesia technique involving injection of local anesthetic into the epidural space to block nerve impulses from the lower spinal segments, commonly used for pain relief during labor. - **Sympathetic Blockade** — The interruption of sympathetic nerve impulses, often a side effect of epidural anesthesia, leading to vasodilation, decreased systemic vascular resistance, and potentially hypotension. - **Uteroplacental Perfusion** — The flow of maternal blood through the uterine arteries to the placenta, which is essential for fetal oxygenation and is directly dependent on maternal blood pressure. - **Maternal Hypotension** — Abnormally low blood pressure in the mother, defined in labor as a systolic pressure below 100 mmHg or a significant drop from baseline, a common complication of epidural anesthesia. ## 같은 주제 문제 - [A multigravida client at 38 weeks gestation receives an epidural anesthesia for pain manag…](https://mymerci.kr/pages/nclex_q.php?qn_id=543008) - [A primigravida at 41 weeks gestation is in early labor and requests epidural anesthesia fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=543009) - [A laboring client at 39 weeks gestation receives an epidural anesthesia for pain managemen…](https://mymerci.kr/pages/nclex_q.php?qn_id=543010) - [A pregnant woman at 39 weeks gestation is receiving epidural anesthesia during labor. Whic…](https://mymerci.kr/pages/nclex_q.php?qn_id=543011) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._