A nurse is performing an assessment on a client who is 1 hour postpartum following a spontaneous vaginal birth. The nurse observes a sudden, heavy gush of vaginal bleeding. Upon palpation, the uterus is boggy and displaced to the right of the umbilicus. Arrange the following nursing interventions in the priority order of execution.
- 1Firmly massage the uterine fundus until it is well contracted.
- 2Assist the client to empty the bladder or insert a straight catheter.
- 3Administer a prescribed uterotonic medication such as oxytocin.
- 4Increase the flow rate of isotonic intravenous fluids.
- 5Weigh the blood-saturated perineal pads to quantify blood loss.
Answer
The correct sequence of actions is: 1) Firmly massage the uterine fundus, 2) Assist the client to empty the bladder, 3) Administer a prescribed uterotonic medication, 4) Increase the flow rate of intravenous fluids, and 5) Weigh the perineal pads.
In the event of postpartum hemorrhage due to uterine atony, immediate manual stimulation via fundal massage is the absolute first priority to stop bleeding. The observation of a uterus displaced to the right indicates a full bladder, which must be emptied next because it physically impedes the uterus from staying contracted. After manual and anatomical corrections, uterotonic medications are administered to sustain the contraction. Fluid resuscitation follows to address the physiological impact of the blood loss, and finally, exact quantification of blood loss is performed to guide ongoing therapy.
Step-by-Step Solution
Key Concept
Prioritization of nursing interventions for postpartum hemorrhage caused by uterine atony and bladder distension.