Final answer:
The highest priority nursing diagnosis for Carla Hernandez during an umbilical cord prolapse is Impaired Gas Exchange due to the risk of fetal hypoxia.
Step-by-step explanation:
The nursing diagnosis with the highest priority in the care of Carla Hernandez during an umbilical cord prolapse is Impaired Gas Exchange.
When an umbilical cord prolapse occurs, the umbilical cord slips through the cervical opening and comes in contact with the vagina before the baby does. This situation can result in the cord being compressed during contractions, which decreases or completely cuts off blood flow and oxygen to the fetus, leading to impaired gas exchange. This impaired gas exchange can result in fetal hypoxia, which is a medical emergency requiring immediate intervention to prevent serious fetal injury or death. The priority is to alleviate the compression on the umbilical cord either by the healthcare provider manually lifting the presenting part of the fetus off the cord or by an emergency cesarean section if necessary. Prompt actions are crucial as they directly impact the fetal oxygenation and overall outcome. Other diagnoses such as Risk for Infection, Risk for Injury, and Acute Pain are secondary and will be addressed after stabilizing the impaired gas exchange.