A nurse is caring for a client who experienced a complete uterine inversion immediately after delivery of the placenta. What is the nurse's highest priority action?

Upon recognition of a complete uterine inversion, the nurse must immediately call for help and prepare to assist the provider with manual replacement of the uterus. Time is critical; the placenta should not be removed if still attached, as this can increase hemorrhage. The provider will insert a gloved hand into the vagina, locate the inverted fundus, and push it through the cervical ring using firm, steady pressure directed toward the umbilicus. The nurse's role includes positioning the client, providing emotional support, and preparing uterotonic medications for administration only after successful replacement.

While manual replacement is the definitive treatment, the nurse must concurrently initiate measures to manage hemorrhagic shock. Establish two large-bore intravenous lines and begin rapid infusion of isotonic crystalloid fluids, such as Lactated Ringer's or 0.9% sodium chloride, as prescribed. Administer oxygen via a non-rebreather mask at 10-15 L/min. Continuously monitor vital signs, level of consciousness, and oxygen saturation. Prepare for potential blood product transfusion if the client does not respond to initial fluid resuscitation.

Once the uterus is successfully replaced, the provider will keep a hand in the uterine cavity to maintain position while uterotonics are administered. The nurse should promptly administer oxytocin as prescribed to stimulate uterine contraction and prevent recurrence. After the uterus is firm and remains in place, the provider will remove the hand. Continue to monitor fundal height and firmness, vaginal bleeding, and vital signs frequently. Prepare for potential use of a uterine tamponade device, such as a Bakri balloon, if atony and bleeding persist.