During labor, for which side effect of an epidural anesthetic should the nurse monitor the client?

Monitoring for urine retention is important during labor with an epidural anesthetic, but hypotension is the most crucial side effect to watch for. Epidural anesthesia can cause a drop in blood pressure due to sympathetic blockade, which can lead to decreased blood flow to the placenta and affect fetal well-being. The epidural blocks the sympathetic nerves, which can result in vasodilation and reduced venous return to the heart, causing hypotension in the mother.

While urine retention can occur due to the diminished sensation from the epidural, leading to decreased urge to void, it is generally not as immediately critical to monitor as hypotension because the nurse can manage it by assisting the client with voiding or offering catheterization. The risk of severe headache is more associated with a post-dural puncture headache than with epidural anesthesia itself during labor. Increased heart rate may not be a direct consequence of the epidural and requires a different assessment focus. Therefore, while urine retention is a concern, hypotension should be the primary focus to ensure maternal and fetal safety.