[Verified Answer]: Nurses’ Notes – 2000: Client is…

Nurses’ Notes – 2000: Client is 38-year-old, G4 P3 at 38 weeks of gestation. Presents for evaluation of labor and spontaneous rupture of membranes (SROM). Client states, “My water broke a couple of hours ago and is a greenish color.” Client also reports contractions began about 4 hr ago and have become consistently stronger and closer together. Electronic fetal monitor applied. Small amount of thin green fluid noted on perineal pad. Contraction palpated, lasted 40 seconds, moderate in intensity. Fetal heart rate (FHR) 165/min. Vaginal examination performed: cervix 4 cm dilated, 70% effaced, 0 station, vertex presentation. Client reports a history of chronic hypertension that has been well-controlled during this pregnancy. Also states was diagnosed with gestational diabetes at 28 weeks of gestation. 2020: Contractions occurring every 4 to 5 min, lasting 40 to 60 seconds. Small amount of bloody show noted when changing disposable pad on bed. Client rates contraction pain as a 5 on a scale of 0 to 10, breathing well through contractions. FHR 168/min, minimal variability. Client denies epigastric pain or visual disturbances. Trace of edema noted to bilateral lower extremities. 2130: Contractions occurring every 3 to 3.5 min, lasting 60 to 80 seconds. Moderate amount of bloody show noted. Vaginal examination performed. Cervix dilated 6 cm, 90% effaced, +1 station. FHR 160/min with minimal variability. Recurrent variable decelerations noted with decrease in FHR to 110/min. Client tearful and anxious. Rating contraction pain as an 8 on a scale of 0 to 10, requests epidural. Anesthesiologist notified.