The nurse is participating in an obstetrical emergency simulation in which a client is hemorrhaging after birth due to uterine inversion. When describing interventions, which statement by the nurse indicates a need for further education?

Question

The nurse is participating in an obstetrical emergency simulation in which a client is hemorrhaging after birth due to uterine inversion.  When describing interventions, which statement by the nurse indicates a need for further education?

Quizplus · Accepted Answer

11ecbb05_cc0e_6aa0_b433_6363e2b2a81c_MD0009_00 Uterine inversion is a rare, obstetrical emergency that occurs after birth when the uterine fundus collapses (partially or completely) into the uterine cavity, causing sudden hemorrhage, severe pelvic pain, and hypovolemic shock. Successful manual replacement of the inverted uterus through the vaginal canal by the health care provider (HCP) is the first step in resolving the inversion and requires a soft, uncontracted uterus. Tocolytics (eg, terbutaline) or inhaled anesthetics may be needed to assist with uterine relaxation. Uterotonic medications (eg, oxytocin, carboprost) must be delayed or discontinued until after the HCP has corrected the inversion (ie, manual uterine replacement) (Option A). After uterine replacement, uterotonics are administered to reinforce its location in the pelvis and control further bleeding. (Option B) Initiating a second, large-bore (eg, 18-gauge) IV line is an important intervention that allows for adequate volume resuscitation (eg, fluids, blood products) as needed for hemorrhage. (Option C) Serial blood pressure monitoring (eg, every 3-5 min) helps the nurse assess for worsening hypovolemic shock. (Option D) If manual uterine replacement through the vagina is unsuccessful, emergency laparotomy (ie, replacement via abdominal incision) may be necessary; it is appropriate to notify surgical staff members who will be involved. Educational objective: Uterine inversion is a postbirth complication in which the uterine fundus collapses into the uterine cavity, resulting in sudden hemorrhage and hypovolemic shock. Initially, a soft, uncontracted uterus is needed to correct the inversion (ie, manual uterine replacement), and uterotonic administration (eg, oxytocin) is delayed until after the uterus is replaced.

The Nurse Is Participating in an Obstetrical Emergency Simulation in Which