Kidneys excrete the majority of the body’s potassium. When renal tissue is impaired (e.g., acute kidney injury [AKI]), serum potassium levels can rise to dangerous levels. Potassium plays an important role in the electrical conduction system of the heart. Hyperkalemia places the client at high risk for life-threatening cardiac arrhythmias like ventricular fibrillation. The nurse should assess this client first for signs of hyperkalemia (e.g., nausea, chest pain, muscle weakness) and initiate close cardiac monitoring.

Umbilical cord prolapse occurs when the cord protrudes into the cervix/vagina in front of the fetal presenting part. It is characterized by fetal heart rate (FHR) decelerations, most frequently following membrane rupture (e.g., amniotomy). When cord prolapse occurs, the presenting part compresses the umbilical cord (e.g., fetal head), preventing blood flow to the fetus and causing fetal hypoxia.
If cord prolapse is suspected, the nurse should place the client in Trendelenburg, modified Sims, or knee-to-chest position. These positions use gravity to reduce cord compression and prevent further pelvic engagement by the presenting part. Additionally, the nurse should perform a vaginal exam, assessing for the umbilical cord (e.g., palpable pulsating loop). If confirmed, the nurse should lift the presenting part off the umbilical cord, reducing compression and improving fetal oxygenation until delivery via emergent cesarean section.

Bladder distention displaces the uterus away from the midline (i.e., umbilicus) and pushes it upward (e.g., U+2). A full bladder interferes with uterine descent and impedes uterine contractions, causing uterine atony (i.e., relaxed, boggy, hypotonic).  With uterine atony, the uterus is unable to contract properly to clamp uterine arteries and prevent excessive bleeding. To improve uterine tone and prevent further bleeding and postpartum hemorrhage (PPH), the nurse should empty the client’s bladder (e.g., assist to the bathroom, in and out urinary catheterization).

When caring for clients who have experienced loss, the nurse should use therapeutic communication to assess the client’s coping. Making broad observations such as, “This is a big change for you,” neutrally acknowledges the client’s situation and shows empathy towards the client’s experience without making assumptions. “I can’t begin to imagine how you are feeling” provides an opportunity for the client to express their emotions, encouraging further conversation about how they are coping with this loss.