A multigravida client is recovering in the postpartum unit 6 hours after a prolonged vaginal birth. Upon assessing the client's abdomen, the practical nurse finds the uterine fundus to be soft, uncontracted, and level with the umbilicus. A heavy, continuous flow of bright red lochia is pooling on the bed linens. Which immediate action should the practical nurse implement?
- Initiate continuous, firm massage of the uterine fundus while calling the registered nurse for assistance.Answer
- BAdminister a scheduled dose of intravenous push oxytocin to stimulate uterine involution.
- CApply a fresh perineal pad and document the heavy lochia flow as an expected finding for a multiparous client.
- DObtain a full set of vital signs to determine if the client is experiencing hypovolemic shock before intervening.
Answer
The practical nurse should immediately begin continuous, firm massage of the boggy uterine fundus while simultaneously calling the registered nurse for assistance.
The client is exhibiting classic signs of uterine atony, which is a leading cause of postpartum hemorrhage. The immediate priority intervention to control this active bleeding is to perform continuous, firm massage of the uterine fundus to mechanically stimulate contraction. Because the client requires emergent care that will involve intravenous fluids and medications outside the practical nurse's scope of practice, the nurse must simultaneously call the registered nurse for assistance.
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Key Concept
Prioritization and Scope of Practice in Postpartum Hemorrhage