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Difficulty: HardAnte/Intra/Postpartum and Newborn Care

A 28-year-old client at 35 weeks gestation is transported to the emergency department via ambulance following a severe motor vehicle collision. The client is secured flat to a rigid backboard with a cervical collar in place. She is conscious, visibly anxious, and reporting generalized abdominal tenderness. Current vital signs are blood pressure 92/54 mm Hg, heart rate 122 beats/min, respiratory rate 26 breaths/min, and oxygen saturation 93% on room air. Which action should the nurse perform FIRST?

  1. Laterally tilt the entire backboard 15 to 30 degrees to the left.Answer
  2. B
    Obtain a portable obstetric ultrasound to evaluate for placental abruption.
  3. C
    Prepare to administer uncrossmatched O-negative blood for suspected hemorrhage.
  4. D
    Apply a continuous external fetal monitor to assess the fetal heart rate.

Answer

The nurse must first laterally tilt the entire backboard 15 to 30 degrees to the left to manually displace the uterus and relieve aortocaval compression.
The correct answer identifies that a pregnant woman in her third trimester will suffer from severe decreased cardiac output if left lying flat on her back due to the weight of the uterus compressing the inferior vena cava. Tilting the backboard 15 to 30 degrees to the left displaces the uterus, instantly removing the mechanical obstruction to blood flow and improving the client's shock state while safely maintaining cervical spine precautions.

Step-by-Step Solution

1
Assess the priority needs of a pregnant trauma client.
Maternal stabilization and addressing the ABCs (Airway, Breathing, Circulation) take absolute precedence over fetal assessment.
Fetal survival is entirely dependent on maternal physiological stability and adequate perfusion.
2
Analyze the client's vital signs and physical positioning.
The client is exhibiting tachycardia and hypotension while secured flat on a rigid backboard.
In the third trimester, the heavy gravid uterus compresses the inferior vena cava when the client is supine, causing or worsening a state of shock (supine hypotensive syndrome).
3
Determine the most immediate, effective intervention to restore circulation.
The backboard must be tilted laterally to manually displace the uterus off the major blood vessels.
Relieving aortocaval compression immediately restores venous return, improves cardiac output, and is a mandatory prerequisite for any subsequent fluid or blood resuscitation to be effective.

Key Concept

In obstetric trauma resuscitation, displacing the gravid uterus off the inferior vena cava is a critical first step to restore maternal venous return and cardiac output before implementing other interventions.
Estimated Time:1m 30s
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Topics

Ante/Intra/Postpartum and Newborn Care

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