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Difficulty: MediumAnte/Intra/Postpartum and Newborn Care

A practical nurse is caring for a client who is three hours postpartum following a rapid vaginal delivery of a large-for-gestational-age infant. The nurse palpates the uterine fundus and notes it is firm, midline, and at the level of the umbilicus. However, the nurse observes a continuous, steady trickle of bright red blood from the vagina. Which action is the priority for the nurse to take?

  1. Notify the registered nurse of the assessment findings.Answer
  2. B
    Document the observation as an expected lochia pattern.
  3. C
    Initiate vigorous massage of the client's uterine fundus.
  4. D
    Independently increase the rate of the client's intravenous fluids.

Answer

Notify the registered nurse of the assessment findings.
A continuous trickle of bright red blood despite a firm, midline fundus strongly suggests a genital tract laceration (such as a cervical or vaginal tear) rather than uterine atony. Because evaluating and repairing a laceration is outside the practical nurse's scope of practice, the priority is to immediately notify the registered nurse for further assessment and intervention.

Step-by-Step Solution

1
Analyze the clinical findings.
The fundus is firm and midline, indicating the uterus is contracted. However, there is a continuous trickle of bright red blood.
Differentiating the source of postpartum bleeding is essential for determining the appropriate intervention.
2
Correlate findings with potential complications.
A firm uterus with active bleeding suggests a trauma-related cause, such as a laceration of the cervix or vagina, which is a known risk following a rapid delivery of a large infant.
Understanding the pathophysiology of postpartum hemorrhage guides safe clinical decision-making.
3
Determine the practical nurse's scope of practice.
Identifying and repairing a vaginal or cervical laceration requires advanced assessment by a registered nurse or healthcare provider.
Practical nurses must operate within their legal scope of practice and safely delegate or report complex situations.
4
Select the priority action.
The nurse must immediately notify the registered nurse to ensure the client receives timely medical evaluation.
Prompt communication of abnormal findings prevents clinical deterioration.

Key Concept

Postpartum Hemorrhage and Scope of Practice
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Topics

Ante/Intra/Postpartum and Newborn Care

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