Question

The nurse takes measures to preserve the integrity of the visible umbilical cord prolapse to maintain blood flow to the fetus. Which of the following are appropriate measures? Select apply all that.

- Monitor the color, amount, and smell of the amniotic fluid
- Check the maternal temperature, heart rate, and blood pressure
- Push the exposed umbilical cord back into the open vagina
- Use a gloved hand to lift the presenting part off the cord
- Assess the exposed umbilical cord for color and pulsation

Answer 1

The appropriate measures to preserve the integrity of the visible umbilical cord prolapse and maintain blood flow to the fetus include monitoring the amniotic fluid, assessing the exposed umbilical cord, and using a gloved hand to lift the presenting part off the cord.

Step-by-step explanation:

The appropriate measures to preserve the integrity of the visible umbilical cord prolapse and maintain blood flow to the fetus include:

• Monitor the color, amount, and smell of the amniotic fluid.
• Assess the exposed umbilical cord for color and pulsation.
• Use a gloved hand to lift the presenting part off the cord.

These measures help ensure that the blood flow to the fetus is maintained and prevent any potential complications.