The practical nurse (PN) is caring for a postpartum client who delivered 5 hours ago and has saturated a perineal pad with a few clots within 15 minutes.
Which action is most important for the PN to implement?
A. Increase the intravenous infusion rate.
B. Massage the fundus.
C. Notify the healthcare provider.
D. Assess the vital signs.
The Correct Answer and Explanation is:
In this scenario, the most important action for the practical nurse (PN) to implement is:
B. Massage the fundus.
Explanation:
After childbirth, postpartum hemorrhage can be a serious and immediate concern. The fact that the client has saturated a perineal pad with clots within 15 minutes indicates potential abnormal bleeding or uterine atony. Here’s why massaging the fundus is crucial:
- Uterine Atony: One of the most common causes of early postpartum hemorrhage is uterine atony, where the uterus fails to contract effectively after delivery. This condition can lead to excessive bleeding. Massaging the fundus helps stimulate uterine contractions and can often resolve mild uterine atony, reducing the amount of bleeding.
- Assessment and Intervention: Massaging the fundus is an immediate, direct intervention that can help manage the bleeding. The nurse should first ensure that the fundus is properly positioned and firm. If the fundus is soft or boggy, gentle but firm massage can help promote contraction and prevent further bleeding.
- Importance of Monitoring: While increasing the intravenous infusion rate, notifying the healthcare provider, and assessing vital signs are also important actions in managing postpartum hemorrhage, they are secondary to the immediate step of addressing the uterine atony. Fundal massage is a practical and immediate step that can have a significant impact on the situation.
- Timely Action: The effectiveness of fundal massage can often be assessed quickly. If the fundus firms up and bleeding decreases, it indicates that the intervention is working. If not, further steps such as notifying the healthcare provider and considering additional interventions will be necessary.
In summary, massaging the fundus is a critical initial intervention in managing postpartum hemorrhage due to uterine atony. It directly addresses a common cause of excessive bleeding and helps stabilize the client before other interventions are considered.