Report sudden dyspnea, hypotension, cyanosis, or cardiovascular collapse in labor or postpartum immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse assesses the amniotic fluid of a laboring client and notes it is green and thick. What does this finding indicate, and what is the priority concern?
Answer: B. Green, thick amniotic fluid indicates meconium-stained fluid, raising concern for fetal hypoxia and meconium aspiration syndrome at birth. The team should prepare for possible neonatal resuscitation and suctioning if the newborn is not vigorous. Clear fluid is normal; bloody or cloudy fluid suggests other issues.
Question 2 of 5
The nurse notes that a laboring client at term has amniotic fluid that is green and thick after membrane rupture. What does this finding most likely indicate?
Answer: B. Green, thick amniotic fluid indicates the presence of meconium. Meconium-stained fluid may signal fetal stress and raises the risk of meconium aspiration, requiring the team to be prepared for neonatal resuscitation.
Question 3 of 5
A client with cirrhosis develops abdominal pain, fever, and worsening ascites. Spontaneous bacterial peritonitis is suspected. Which diagnostic test should the nurse anticipate?
Answer: A. Spontaneous bacterial peritonitis is diagnosed by sampling the ascitic fluid, so the nurse anticipates a diagnostic paracentesis with cell count and culture of the fluid; a high neutrophil count in the ascitic fluid confirms infection. A barium swallow, colonoscopy, and skin biopsy do not evaluate ascitic fluid infection.
Question 4 of 5
A client is admitted with extensive burns. During the emergent (resuscitative) phase in the first 24 to 48 hours, which fluid and electrolyte change does the nurse expect?
Answer: A. In the emergent phase, increased capillary permeability causes fluid, sodium, and protein to shift from the intravascular space into the interstitium, producing hypovolemia and edema. Potassium leaks from damaged cells, causing hyperkalemia, while sodium is trapped in edema fluid, producing hyponatremia. Hemoconcentration raises the hematocrit. The opposite shifts occur later in the diuretic phase.
Question 5 of 5
A client with burns covering 40% of the body surface area is 18 hours post injury. Which electrolyte shift does the nurse expect during this emergent phase?
Answer: B. In the first 24-48 hours after a major burn (emergent/fluid shift phase), fluid and potassium move out of damaged cells into the extracellular space, and massive capillary leak occurs. The result is hyperkalemia (from cell destruction) along with hyponatremia as sodium is trapped in edema fluid. Hypokalemia develops later in the diuretic (recovery) phase.
Keep the streak going with more questions like these, each with a full rationale.
What is amniotic fluid embolism?
It usually occurs during labor, delivery, or immediately postpartum. Onset is abrupt and mortality is high, so immediate resuscitation is required.
Key points to remember
- Classic triad: sudden hypoxia/respiratory distress, hypotension/cardiovascular collapse, and coagulopathy (DIC).
- Early signs may include acute dyspnea, restlessness, chest pain, cyanosis, and a feeling of impending doom.
- DIC causes uncontrolled bleeding from the uterus, IV sites, and incisions.
- Treatment is supportive: aggressive oxygenation/ventilation, circulatory support, and correction of coagulopathy with blood products.
- Care requires a rapid multidisciplinary response and often ICU-level support.
- If undelivered, emergent delivery of the fetus is performed to improve maternal resuscitation.
Signs & symptoms
- Sudden dyspnea, hypoxia, cyanosis
- Hypotension, cardiac arrest
- DIC → uncontrolled bleeding
Nursing priorities
- Call a rapid response/code and provide immediate high-flow oxygen and prepare for intubation/CPR.
- Position appropriately, establish large-bore IV access, and give fluids/vasopressors as ordered.
- Anticipate and administer blood products (PRBCs, FFP, platelets, cryoprecipitate) for DIC.
- Continuously monitor maternal vitals, oxygenation, and fetal status; prepare for emergent delivery.
- Provide emotional support to the family during the emergency.
Labs & values
Patient teaching
- Because AFE is sudden and unpredictable, teaching focuses on informing the family during/after the emergency.
- Explain interventions and monitoring to support the family during the crisis.
Red flags: report now
- Report sudden dyspnea, hypotension, cyanosis, or cardiovascular collapse in labor or postpartum immediately.
- Report uncontrolled bleeding/oozing from IV sites or incisions (DIC).
- Report acute loss of consciousness or cardiac arrest and begin resuscitation.
References
Clinical references for this topic
