A client in active labor who received an epidural 20 minutes ago reports feeling nauseated and lightheaded. Which action should the nurse perform first?

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An epidural block (a form of regional anesthesia) can provide effective pain relief during labor; however, it also inhibits the sympathetic nervous system (SNS). SNS inhibition causes peripheral vasodilation, which may produce significant hypotension (ie, systolic blood pressure <100 mm Hg, ≥20% decrease from baseline). If a client exhibits hypotensive symptoms (eg, lightheadedness, nausea) while receiving epidural anesthesia, the nurse should first assess blood pressure to confirm the presence of hypotension before intervening (Option C). If hypotension is present, initial nursing interventions include administering an IV fluid bolus to increase blood volume and positioning the client in the left lateral position to alleviate pressure on the vena cava. (Option A) IV ondansetron (Zofran) may help alleviate symptoms of nausea and vomiting, but evaluation and correction of potential hypotension should be completed first. (Option B) If hypotension persists after initial interventions or fetal distress occurs, further measures include administering IV vasopressors (eg, phenylephrine, ephedrine) and applying 8-10 L/min oxygen via face mask to increase blood flow and oxygen delivery to the fetus. (Option D) Nausea may occur independently of hypotension due to labor pain or as a sign of complete dilation. However, this client also has lightheadedness and is receiving epidural anesthesia; hypotension is extremely common with epidural anesthesia. Educational objective: Epidural blocks can inhibit the sympathetic nervous system, causing peripheral vasodilation leading to hypotension. Hypotensive symptoms include lightheadedness and nausea. The nurse should first assess blood pressure and then intervene (eg, IV fluids, left lateral positioning, oxygen) as appropriate.

A Client in Active Labor Who Received an Epidural 20