A nurse is assisting with a vaginal delivery. Following the delivery of the fetal head, the head retracts tightly against the maternal perineum. Arrange the following nursing actions in the correct sequence of priority.
- 1Instruct the client to stop pushing and immediately call for additional clinical assistance.
- 2Assist the client into a position with her hips sharply flexed and thighs abducted against her abdomen.
- 3Apply firm, downward pressure directly over the maternal symphysis pubis.
- 4Prepare to assist the primary healthcare provider with internal rotational maneuvers.
- 5Assess the newborn for localized trauma, such as a fractured clavicle or brachial plexus injury.
Cevap
The correct sequence is: stop pushing and call for help, perform the McRoberts maneuver, apply suprapubic pressure, assist with internal maneuvers, and assess the newborn for trauma.
Shoulder dystocia is a critical emergency requiring immediate sequential actions. First, pushing must cease to prevent further impaction, and additional help is summoned (including neonatal staff). Next, the McRoberts maneuver (hyperflexion of legs) is performed to widen the pelvic outlet. If unsuccessful, suprapubic pressure is applied to manually dislodge the anterior shoulder. If these external maneuvers fail, the nurse prepares to assist the provider with internal maneuvers. Finally, after delivery, the newborn is at high risk for trauma (e.g., fractured clavicle, brachial plexus injury) and must be thoroughly assessed.
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Anahtar Kavram
Management of shoulder dystocia follows a specific algorithmic sequence prioritizing non-invasive maneuvers to safely dislodge the fetal shoulder and prevent birth trauma or hypoxia.