Walkthrough: Basic Care and Comfort Q2 – NCLEX-RN®

00:01 A client has specified a birthing plan for natural child birth that includes no pharmacological means to reduce pain.

00:09 While in labor, the client is extremely uncomfortable and rates the pain level a 10.

00:14 Which nursing action supports the client during this time? Select all that apply.

00:21 Okay, now let's walk back through this. Just in case you're not the biggest fan of labor and delivery, know that everyone will get these type of question on the NCLEX.

00:32 You're going to have these questions come up in basic care and comfort, so you want to make sure you're ready.

00:38 No worries, we're going to help you know what you need to know.

00:41 Alright, so a client has specified a birthing plan. This is really important.

00:48 We're going to honor, respect, and support that birthing plan as much as we can.

00:53 So they have a specific plan and the plan is no pharmacological means to reduce pain.

01:01 Wow, I think that's impressive but I digress. Let's go back.

01:07 While in labor, the client is extremely uncomfortable and rates the pain level a 10.

01:14 Okay, that's congruent with what we would see with labor, okay, they rate it at 10, which nursing action supports the client during this time? Select all that apply.

01:28 So let's put this into our own words.

01:30 I've got a client who has a specific birthing plan that says, no pharmacological means, no drugs.

01:37 Now they're telling me they have pain a level of 10, and that's on the scale of 1 to 10, which is appropriate for nursing action that supports the client during this time.

01:50 Select all that apply. Pause the video, put the question into your own words, and then remember to ask yourself that question five different times.

02:00 Write down only the numbers 1, 2, 3, 4, 5 on your scratch paper.

02:05 Then with each question, I want you to cross through, right? Or circle, depending on if it answers the question correctly or incorrectly.

02:17 You're looking for something that supports the client during this time.

02:22 What's particular about this client? They're in childbirth and they have a specific plan that says, no drugs, but now they're telling you they're in pain.

02:34 Okay, pause the video. Do the work, come on back and we'll walk through it together.

02:49 Good job of doing the work. I know it's hard and wrestling with these questions take a lots of mental energy, but you can do it.

02:57 Now, let's look at these five options for a women whose in labor, has a specific birthing plan that says she doesn't want drugs, she's in a significant amount of pain, what nursing action supports her during this time? So does number 1 support this particular client? Avoid touching the client during the labor process.

03:19 Actually, no. Because therapeutic touch used appropriately is appropriate during labor.

03:28 So you don't want to avoid touching the client, but you want to make sure you use therapeutic touch in a way that's appropriate with this client.

03:36 And, remember, don't ever touch a client without asking their permission first. So, number 1, you're out.

03:44 Number 2. Is it appropriate with someone with this specific birthing plan, no drugs, who's in pain to remind them, that it's okay to request an epidural.

03:55 Now, would that be supportive during this time? No, actually it's not.

04:01 Here's what I want to make sure you don't do in a question.

04:05 Now, sometimes you've heard me say, don't be Spielberg.

04:07 Like don't look for things that aren't there.

04:10 In this case, I'm going to say, don't put your values on to this patient.

04:17 If you're thinking, huh, if I was a 10, I'd be want that epidural and I'd want somebody to remind me.

04:23 But look at what this client did, they made a birthing plan, they knew they were going to be in pain and they didn't want drugs.

04:31 Are you being supportive if you keep reminding them, you know, you could have an epidural.

04:36 You know, you could have an epidural. No.

04:39 Now if the patient changes their mind, what's my job as a nurse, make it happen.

04:44 If they say, hey, I wanted to do this, but I can't. I want an epidural.

04:49 I'm on the phone to the healthcare provider, right? My job is to support the client's plan, not do for the client what I think is best regarding pain control.

05:01 While the client may be at a 10, the client may be okay with that.

05:05 They may have prepared for it. Doesn't change the fact that they're in extreme pain, but they may not want pain medication.

05:12 Now, as the labor process is starting, if you're in there, you might tell them, hey, I see your birth plan is that you don't want medications, I will support you in that, but please know, at any time, if you'd like to change your mind or talk about some options for pain control, just let me know.

05:29 Otherwise, I don't want to keep bringing this up during your labor process, because I want to honor and respect the type of experience you want to have. See? That way you've got it out of the way, you're helping the pain by letting the patient know, if you chose for me to take another intervention or another step, I would be happy to do that.

05:48 But I'm not going to keep reminding you that it's there.

05:51 Trust me, someone in pain, knows that pain treatment is available.

05:56 But it's likely, this client is choosing this option because they don't want their baby exposed to medications. So number 1, number 2, out.

06:07 Number 3. Encourage the client to use hydrotherapy.

06:11 Well, the birthing plan didn't say anything about not wanting to use hydrotherapy, and if you're wondering what hydrotherapy looks like for client that's laboring, I had not been exposed to this. My niece just had a baby and she did fantastic.

06:26 She used hydrotherapy, which means she was in a small pool helping through the labor pains and that's considered hydrotherapy.

06:34 She found it comforting, so we can encourage the client to use hydrotherapy, particularly because they're not using any pain medications.

06:43 Again, it's got to be the client's choice.

06:47 So you can say, other people have used hydrotherapy and found it helpful in helping them to relax and to deal with the pain.

06:56 Would you like to try that? Number 4, I'm just going to tell you I hate this answer, but let me walk through and we'll explain why.

07:08 Tell the client to breathe and relax. Are you kidding me? The client is in labor, they've got a pain level of 10.

07:18 They already have thought through what they want to do.

07:21 You, telling the client to breathe and relax, is not supporting the client.

07:27 So number 4 is not an appropriate option. This doesn't support the client during this time.

07:34 You know, telling to someone to relax never seems to work, does it? Number 5, allow the spouse to assist the client with aroma therapy.

07:45 Again, don't put your values on the situation. Could aroma therapy help the client relax? Absolutely. Now the client can choose if they want to or don't want to, but don't stop the spouse from assisting the client with aromatherapy.

08:01 So, let's review. Number 1, don't avoid touching but only use appropriate therapeutic touch.

08:09 Number 2, remind the client that's it okay to request an epidural? No.

08:15 You don't want to nag at them about this.

08:18 Remember, you make the statement at the beginning that says if you need anything or change your mind, I'll be - support you, so that's where you'll leave it.

08:26 Don't keep reminding them during labor that they can have an epidural.

08:31 Number 3, hydrotherapy. If that's what they want to do, that's great.

08:35 Number 4. Tell the client to breathe and relax, that is not therapeutic, that is not supportive.

08:42 Number 5, fine. If that's an option they want to do, you're not going to stop it, you will allow the spouse to assist the client with aroma therapy.

08:52 Okay, how did you do? Remember, here's where you get the biggest payoff for the work that you did.

08:57 Take a look at your answers. Did you miss any? Did you pick one that should have been left out? Did you leave one out that should have been picked? Take some time to think through what was your rationale for that? Is there anything that needs to go in your notebook, that was something you didn't know about the labor process? Alright. Make sure you get all that done, pause the video, write your notes, think through the question, see what you want to take from this question and apply to other questions, and then, join us for another question.