When assessing a multigravida on the first postpartum day, the nurse finds a moderate amount of lochia rubra, with the uterus firm and three fingerbreadths above the umbilicus. What action should the nurse implement first?
A.
Check for a distended bladder.
B.
Review the hemoglobin to determine hemorrhage.
C.
Massage the uterus to decrease atony.
D.
Increase intravenous infusion.
The correct answer and Explanation is :
The correct answer is A. Check for a distended bladder.
Explanation:
On the first postpartum day, the assessment of lochia rubra and the position of the uterus are critical for evaluating the mother’s recovery. Lochia rubra is expected during the early postpartum period, but the presence of a moderate amount alongside a firm uterus that is three fingerbreadths above the umbilicus indicates that there may be an underlying issue.
One common cause of a uterus that is not in its expected position (midline and at or below the umbilicus) is bladder distention. After childbirth, women may have difficulty voiding due to factors like swelling, pain, or fear of discomfort. If the bladder is distended, it can push the uterus upward, which may contribute to abnormal uterine positioning and increased lochia. Therefore, assessing for bladder distension is the priority action. If the bladder is indeed distended, relieving that pressure by having the patient void can help reposition the uterus, potentially reducing lochia output and promoting uterine involution.
While reviewing hemoglobin levels (option B) is important for assessing potential hemorrhage, it is more effective to first address the physical positioning of the uterus through bladder assessment. Massage (option C) is also useful for addressing uterine atony, but in this case, the uterus is firm, indicating that atony is not the issue. Increasing intravenous infusion (option D) may be necessary if significant hemorrhage is detected, but checking for a distended bladder should be the first step to rule out one of the most common causes of a displaced uterus and excessive lochia. By managing bladder distention first, the nurse can facilitate the normalization of uterine positioning and help ensure a safer postpartum recovery.