Final answer:
In the event of an umbilical cord prolapse during labor, a nurse must act quickly to alleviate pressure on the cord, possibly by repositioning the patient and manually elevating the presenting fetal part, while waiting for emergency delivery interventions. Ongoing fetal heart rate monitoring and patient reassurance are also vital.
Step-by-step explanation:
If a nurse performing a vaginal exam on a patient in labor observes the umbilical cord protruding from the vagina, it's an obstetrical emergency referred to as an umbilical cord prolapse. Immediate actions are crucial to minimize the risk of fetal distress or asphyxia. After calling for assistance, the nurse should help alleviate pressure on the cord. To do this, the nurse can instruct the patient to assume a knee-chest position or to lie with the hips elevated (Trendelenburg position) which can help to relieve the compression of the cord. If the cord is visible, the nurse may also use a sterile gloved hand to gently push the presenting part of the fetus upward and away from the cord. These efforts are aimed at maintaining blood flow through the umbilical cord until an expedited delivery, usually by emergency cesarean section, can be executed.
The steps described are to ensure the best possible outcomes in a situation where every second counts. It's also crucial to monitor the fetal heart rate, as changes might indicate fetal distress. The nurse must continue to provide calm reassurance to the patient during this stressful time, and thoroughly document all actions and observations until the patient is transferred to the appropriate personnel for definitive care.