A nurse is caring for a postpartum client who has a boggy uterus.
Which of the following actions should the nurse take?
A.
Administer oxytocics as prescribed
B.
Encourage the woman to empty her bladder regularly
C.
Provide a peri-bottle with warm water for cleansing after each voiding or bowel movement
D.
Advise the woman to avoid tampons.
The Correct Answer and Explanation is:
Correct Answer: A. Administer oxytocics as prescribed
A boggy uterus in a postpartum client is a significant clinical finding that requires prompt intervention. A “boggy” or soft uterus indicates that the uterine muscles are not contracting effectively, which can lead to uterine atony—a major cause of postpartum hemorrhage (PPH). This condition occurs when the uterus fails to contract properly after childbirth, leading to excessive blood loss.
Why Administer Oxytocics?
Oxytocics are medications that stimulate uterine contractions. These drugs, such as oxytocin (Pitocin), are commonly prescribed to manage or prevent uterine atony. Administering oxytocics helps the uterus contract more effectively, reducing the risk of hemorrhage by compressing the blood vessels that were connected to the placenta. This is crucial because the primary function of the uterine contractions postpartum is to clamp down on these vessels and prevent excessive bleeding.
The Role of Oxytocin
Oxytocin is a natural hormone released during labor and after delivery that promotes uterine contractions. When administered synthetically, it can enhance these contractions. If the uterus remains boggy despite efforts like fundal massage, the administration of oxytocics is often necessary to achieve the desired firmness of the uterus, thereby minimizing the risk of hemorrhage.
Other Considerations
While other options like encouraging bladder emptying (Option B) and providing a peri-bottle for cleansing (Option C) are important aspects of postpartum care, they are not immediate actions for managing a boggy uterus. A full bladder can indeed impede uterine contraction, so bladder management is vital; however, the priority action remains administering oxytocics. Avoiding tampons (Option D) is related to infection prevention and is generally advised, but it does not address the acute issue of uterine atony.
Conclusion
In summary, the most critical action a nurse should take when caring for a postpartum client with a boggy uterus is to administer oxytocics as prescribed. This intervention directly addresses the underlying problem of uterine atony and is essential for preventing postpartum hemorrhage, a leading cause of maternal morbidity and mortality.