Giselle is a 30-year-old G1 P0 admitted at 39 weeks

1. Giselle is a 30-year-old G1 P0 admitted at 39 weeks of gestation in early active labor. Her cervical exam is 3 cm/100%/?1 vertex. Her membranes are intact. Her contractions are every 4 minutes × 60 seconds. Fetal heart tones are 140 with moderate variability, accelerations present, and no decelerations. She declines medication for pain at this time, but states she might want something later. Her partner is at the bedside and appears anxious.

a. How can the nurse help Giselle cope with the pain of contractions at this time in labor? Give Rationale for your interventions.

a. Four hours later Giselle’s contractions are every 3 minutes and much stronger. Her cervix is now 6 cm/100%/0 station. She is requesting medication for pain but is not sure if she wants an epidural or IV pain medication. How can the nurse counsel her regarding her choices?

a. Giselle decides to use IV pain medication and the nurse-midwife orders 2 g of Butorphanol IV. What should the nurse do to safely manage the administration of the medication and the subsequent care of the patient? Think normal responses to pain medication.

a. Giselle suddenly feels an urge to push and experiences spontaneous rupture of membranes 1 hour after administration of the Butorphanol. The nurse midwife examines Giselle and finds her to be completely dilated with the vertex at +2 station. What should the nurse anticipate? What preparations and plans should be made?