Classmate 1
Based upon what you have learned in this module choose a complication from the following list:
Prolapse Cord – when the umbilical cord is displaced, protruding through the cervix and can comprise fetal circulation (Althoff et al., 2023).
1. Identify a potential cause of the complication?
This can present due to rupture of amniotic membranes, long umbilical cord, and/or position other than vertex of the fetus (Althoff et al., 2023).
2. What are the physiologic changes the RN would notice when assessing a patient with this complication?
The RN will be able to palpitate and/or see the cord and the client will feel something abnormal coming out the vagina. The fetus can be hyperactive then decreased movement, FHR monitoring will show prolonged deceleration – this can be signs of hypoxia of the fetus (Althoff et al., 2023).
3. Identify two priority management interventions the RN would expect the physician to order for a patient with this complication supported by evidence.
Nursing Intervention 1: Call for help immediately and insert two sterile glove fingers into the vagina, apply pressure to the either side of the cord to the fetal presenting to elevate off the cord- the nurse needs to ensure to stay like this until delivery (Althoff et al., 2023).
Nursing Intervention 2: The nurse needs to position patient in knee to chest, Trendelenburg, or lateral semi prone position and put a rolled towel under hip to help release pressure off of cord (Althoff et al., 2023). 10 L/min needs to be administered via facemask for fetal oxygen.
Reference
Althoff, A., Cawley, M. E., Henry, N. J., Gearhart, M., Johnson, J., Roland, P., Wheless, L., & Holman, H. C. (2023). RN Maternal newborn nursing: Review module (12.0). ATI Nursing, Assessment Technologies Institute.
Classmate 2
Based upon what you have learned in this module choose a complication from the following list:
· Uterine rupture
Now respond to these prompts using the chosen complication:
1. Identify a potential cause of the complication? A potential cause for a uterine rupture to occur could be from uterine trauma that occurred from either accidents or surgery such a c-sections (Althoff et al., 2023).
2. What are the physiologic changes the RN would notice when assessing a patient with this complication? Physiological findings that an RN would notice upon assessment of a patient experiencing uterine rupture would be a change in the shape of the uterus along with being able to palpate the fetus, a change in fetal heart rate that presents with bradycardia, decelerations and variability, a halt in contractions, and signs and symptoms related to hypovolemic shock such as low blood pressure, rapid heart rate, and pale cool skin that is clammy (Althoff et al., 2023).
3. Identify two priority management interventions the RN would expect the physician to order for a patient with this complication supported by evidence. Two priority nursing interventions for uterine rupture are preparing the client for an immediate c-section, and administering IV fluids (Althoff et al., 2023).
IV fluids should be administered because when uterine rupture occurs, the patient is at risk for going into shock. It has been shown that hypovolemic shock has been the main cause of death in those with uterine rupture. The reason to prepare for am emergency c-section is due to the fact that uterine rupture is rare and it can be fatal and cause life-threatening complications (2022).
References
Althoff, A., Cawley, M. E., Gearhart, M., Henry, N. J., Holman, H. C., Phillips, B. C., Roland, P., & Wheless, L. (2023). RN Maternal Newborn Nursing (12th ed.). Assessment Technologies Institute.
(2022, December 3). VBAC: Know the pros and cons. Mayoclinic. Retrieved May 13, 2024, from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/vbac/art-20044869#:~:text=Uterine%20rupture%20is%20rare%2C%20happening,to%20prevent%20life%2Dthreatening%20complications.
