Question

The pregnant client is admitted to the emergency room with a prolapsed umbilical cord. Which action is most appropriate? A. Cover the cord with dry, sterile gauze B. Place the client in high Fowler's position C. Push up on the presenting part with an examining finger D. Begin an IV of normal saline at keep-open rate

Short answer

Answer: The most appropriate action a high school teacher can take to help a pregnant client with a prolapsed umbilical cord is to push up on the presenting part with an examining finger. This will help relieve pressure on the prolapsed umbilical cord and minimize the risk of complications until an obstetrical professional arrives to manage the situation.

Step-by-step solution

Understanding the situation

A prolapsed umbilical cord is a medical emergency in which the umbilical cord slips down through the cervix and into the vagina ahead of the baby. If not managed correctly, it can result in reduced oxygen supply to the baby, leading to serious health complications.

Evaluating the Options

We have four actions to consider: A. Cover the cord with dry, sterile gauze B. Place the client in high Fowler's position C. Push up on the presenting part with an examining finger D. Begin an IV of normal saline at keep-open rate

Option A: Cover the cord with dry, sterile gauze

Covering the cord with dry, sterile gauze will help protect the umbilical cord. It reduces the risk of infection and may prevent any damage to the cord. However, it does not directly resolve the emergency situation.

Option B: Place the client in high Fowler's position

High Fowler's position is when the client is sitting up with their back at a 90-degree angle. This position might not be ideal for a pregnant woman with a prolapsed umbilical cord, as it can potentially worsen the situation by allowing the presenting part to descend further and compress the cord.

Option C: Push up on the presenting part with an examining finger

Manually pushing up on the presenting part helps relieve pressure on the prolapsed umbilical cord and can be an important intervention in case of cord prolapse. It aims to reduce the compression on the cord and should be continued until an obstetrical professional arrives to manage the situation.

Option D: Begin an IV of normal saline at keep-open rate

Administering an IV to the client may be beneficial in managing some fetal emergencies. However, in case of a prolapsed umbilical cord, the focus should primarily be on resolving the issue causing the cord to prolapse and ensuring adequate blood flow to the baby.

Choosing the most appropriate action

Based on the evaluation, it is clear that action C—push up on the presenting part with an examining finger—is the most appropriate action in this scenario, as it directly helps relieve pressure on the prolapsed umbilical cord, minimizing the risk of complications until the arrival of the obstetrical professional.

Key concepts

NCLEX-RN Exam Preparation

Preparing for the NCLEX-RN exam requires a thorough understanding of a wide range of nursing knowledge, including how to manage obstetric emergencies like a prolapsed umbilical cord. One critical skill that the NCLEX-RN tests is a nurse's ability to prioritize actions in an emergency. In the case of a prolapsed cord, understanding the immediate steps to alleviate the condition is vital. Candidates should be familiar with the interventions required to optimize outcomes both for the mother and the baby.

Studying conditions such as prolapsed umbilical cord requires a focus on decision-making processes and clinical priorities, as the exam will often present similar scenarios. Key actions, such as manually relieving pressure on the cord, should be understood not only as a rote procedure but also as part of a critical intervention strategy that can significantly impact fetal health.

Obstetric Emergency

An obstetric emergency like a prolapsed umbilical cord demands immediate action to prevent fetal hypoxia and potential death. In such cases, the knowledge and quick response of the healthcare provider can make a lifesaving difference. It's essential to recognize the signs of umbilical cord prolapse and to know the correct position to place the mother in to reduce pressure on the cord.

Immediate Response in Obstetric Emergency

During such emergencies, the presenting part of the fetus, be it the head or the buttock in breech presentation, must be manually elevated to prevent compression of the cord. The mother should be repositioned with the hips elevated (Trendelenburg or knee-to-chest position) rather than in high Fowler's, which could exacerbate cord compression. Such knowledge is imperative for emergency response and is part of essential training for obstetric care providers.

Pregnancy Complications

Complications during pregnancy can occur without warning and can have severe consequences if not managed properly. One such complication is the prolapse of the umbilical cord. This condition arises when the cord comes out of the uterus with or before the presenting part of the fetus during labor. The complication is associated with various factors, including premature rupture of membranes, a long umbilical cord, or a non-cephalic fetal presentation.

Pregnancy complications like a prolapsed cord require an in-depth understanding of the situation. The management includes urgent delivery if the fetus is at a viable gestational age or immediate cesarean section if there's evidence of fetal distress or if vaginal delivery is not quickly forthcoming.

Fetal Health Interventions

Fetal health interventions are measures taken to address complications that arise during pregnancy, labor, or delivery that may threaten the well-being of the fetus. In emergent situations like a prolapsed umbilical cord, the goal is to maintain the oxygen supply to the fetus. These interventions include prompt assessment, protecting the cord from compression, and preparing for expedited delivery if necessary.

For a prolapsed cord, employing a maneuver such as pushing up on the presenting fetal part to alleviate pressure on the cord constitutes an immediate and direct intervention. This effort must be continuous until further medical management can be provided. Additional fetal health interventions may include administering oxygen to the mother, hydration through IV fluids, and monitoring fetal heart rate to assess for signs of distress.