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Zorluk: OrtaAnte/Intra/Postpartum and Newborn Care

A nurse is receiving a client at 36 weeks gestation in the emergency department immediately following a severe motor vehicle collision. The client is immobilized flat on a rigid backboard with a cervical collar applied. The client's blood pressure is 88/50 mmHg and heart rate is 112 beats/minute. Which action should the nurse take first?

  1. Manually displace the client's uterus to the left sideCevap
  2. B
    Elevate the head of the bed to a semi-Fowler's position
  3. C
    Initiate continuous electronic fetal heart rate monitoring
  4. D
    Administer an intravenous bolus of warmed isotonic crystalloids

Cevap

Manually displace the client's uterus to the left side.
The correct answer addresses the immediate mechanical cause of the client's circulatory compromise. At 36 weeks gestation, laying strictly supine on a rigid backboard causes the gravid uterus to compress the inferior vena cava. This significantly reduces venous return to the heart, leading to supine hypotensive syndrome, which manifests as hypotension and compensatory tachycardia. Because the client is on spinal precautions and cannot be tilted or rolled as a single unit without specialized team coordination, manual left uterine displacement must be performed immediately by a responder. This action physically moves the uterus off the major vessels, restoring venous return and maternal cardiac output, which is the absolute priority for stabilizing both the mother and the fetus.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client is in the third trimester of pregnancy, is immobilized flat on a rigid backboard due to trauma, and exhibits signs of hemodynamic compromise (hypotension and tachycardia).
Establishing the baseline clinical picture and identifying abnormal, life-threatening findings is the first step in clinical judgment.
2
Determine the physiological cause of the vital signs.
At 36 weeks gestation, laying strictly supine causes the heavy gravid uterus to compress the inferior vena cava and descending aorta, drastically reducing venous return and cardiac output (supine hypotensive syndrome).
Understanding the anatomical and physiological changes of advanced pregnancy is essential to identifying the root cause of the shock state.
3
Apply prioritization principles (ABCs) alongside safety constraints.
Maternal circulation must be restored immediately. However, the client cannot be tilted or rolled into a lateral decubitus position due to the required spinal precautions.
Spinal alignment must be maintained to prevent neurological injury while simultaneously addressing the critical circulatory compromise.
4
Select the most appropriate initial intervention.
Manual left uterine displacement is the correct and necessary first action to relieve vena cava compression without compromising spinal alignment.
This mechanical intervention restores maternal venous return, which is the foundational priority for both maternal survival and fetal perfusion.

Anahtar Kavram

Maternal physiological adaptation and emergency trauma prioritization (Left Uterine Displacement)
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Ante/Intra/Postpartum and Newborn Care

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