Risk factors and causes
Risk factors and causes ( 4 Questions)
A nurse is assisting with the delivery of a client who has a breech presentation.
The nurse notices that the umbilical cord is protruding from the vagina.
Which of the following actions should the nurse take first?
This is because applying pressure can prevent further compression of the umbilical cord and reduce the risk of fetal hypoxia (lack of oxygen) . The umbilical cord can be flattened or twisted during delivery, which can cause nerve or brain damage .
Placing the client in Trendelenburg position (head down and feet up) may not be enough to relieve the cord compression and may cause discomfort or respiratory distress for the client.
Administering oxygen may not improve the fetal oxygenation if the cord is severely compressed.
Oxygen administration may also delay the urgent delivery of the baby
Clamping and cutting the umbilical cord will cut off the fetal blood supply and oxygenation.
This can lead to fetal death or severe brain injury.
Normal ranges for umbilical cord pH are 7.18 to 7.38 for arterial blood and 7.28 to 7.45 for venous blood.
The correct answer is choice A. Apply pressure to the presenting part with gloved fingers. This is because applying pressure can prevent further compression of the umbilical cord and reduce the risk of fetal hypoxia (lack of oxygen) . The umbilical cord can be flattened or twisted during delivery, which can cause nerve or brain damage .
Choice B is wrong because placing the client in Trendelenburg position (head down and feet up) may not be enough to relieve the cord compression and may cause discomfort or respiratory distress for the client.
Choice C is wrong because administering oxygen may not improve the fetal oxygenation if the cord is severely compressed.
Oxygen administration may also delay the urgent delivery of the baby.
Choice D is wrong because clamping and cutting the umbilical cord will cut off the fetal blood supply and oxygenation.
This can lead to fetal death or severe brain injury.
Normal ranges for umbilical cord pH are 7.18 to 7.38 for arterial blood and 7.28 to 7.45 for venous blood.