A pregnant woman at 28 weeks gestation is lying supine during a non-stress test when she suddenly becomes pale, diaphoretic, and reports feeling dizzy and nauseous. Her blood pressure drops from 110/70 mmHg to 85/45 mmHg. What is the most appropriate immediate nursing intervention?
1Administer oxygen at 2 L/min via nasal cannula
2Elevate the patient's legs above heart level
3Prepare for emergency cesarean delivery
4Position the patient on her left side✓ 정답
해설
Supine hypotension syndrome results from vena cava compression by the gravid uterus. Immediate left lateral positioning is the most effective intervention to relieve compression and restore normal circulation, preventing maternal and fetal complications.
Clinical Judgment
This question assesses the ability to recognize an acute change in condition in a third-trimester pregnant woman and determine the Priority Intervention. The key is to identify that the cause of the symptoms is Supine Hypotension Syndrome. When the mother lies in a supine position, the enlarged uterus compresses the Inferior Vena Cava, preventing venous blood from returning to the heart. This leads to a sudden drop in cardiac output, a fall in blood pressure (120/80 → 90/50), and symptoms of inadequate cerebral perfusion (dizziness, pallor, diaphoresis) and nausea. The quickest and most effective solution is to remove the cause of the compression, that is, to move the uterus away from the inferior vena cava. Therefore, the correct answer is to immediately turn her onto her left side.
Memory Tip: Supine = Side (Left Lateral)! Or remember "Left Lateral for Low pressure." If symptoms appear in the supine position, turning her onto her side is the very first thing to do.
KR vs US
In Korea, it is well known as 'Vena Cava Compression Syndrome' or 'Supine Hypotension Syndrome,' and inducing a left lateral position is standard practice in delivery rooms and during prenatal examinations. The NGN places even greater emphasis on Clinical Judgment and the selection of an immediate intervention based on these physiological changes.
Clinical Practice GuideAvoid placing all mothers after 20 weeks of pregnancy in a supine position. If an examination or procedure is necessary, be sure to support their back with a pillow or towel to maintain a left lateral tilt. When symptoms occur, 1) immediately reposition to the left lateral position, 2) recheck vital signs, and 3) perform fetal heart sound monitoring.CautionOxygen administration (option 1) or leg elevation (option 2) may be supportive interventions, but they do not address the root cause (inferior vena cava compression). Emergency cesarean section (option 3) is not a necessary intervention in this case unless accompanied by other severe complications such as fetal distress. Keep in mind that the question asks for the "most appropriate immediate nursing intervention."
Supine Hypotension Syndrome (Vena Cava Syndrome) — In late pregnancy, when lying on the back, the enlarged uterus compresses the inferior vena cava, leading to reduced venous return, decreased cardiac output, low blood pressure, and related symptoms.
Inferior Vena Cava — Inferior vena cava. A large vein that carries venous blood from the lower body and abdomen to the right atrium of the heart. Easily compressed by the uterus during pregnancy.
Left Lateral Position — Left lateral position. Standard position to prevent and treat supine hypotensive syndrome during pregnancy. Moves the uterus away from the inferior vena cava.
Venous Return — Venous return. The amount of blood returning to the heart through the peripheral veins. One of the major factors determining cardiac output.
Maternal-Fetal Circulation — Maternal-fetal circulation. Compression of the inferior vena cava not only causes maternal circulatory disturbance but can also lead to reduced blood flow to the fetus through the uterine artery (fetal hypoxia).