A nurse is performing fundal massage for a client who has uterine atony and postpartum hemorrhage.
Which of the following actions should the nurse take when performing this procedure?
A.
Use one hand to stabilize the lower uterine segment while massaging the fundus with the other hand
B.
Apply firm pressure on the fundus with both hands until it becomes firm and contracted
C.
Massage the fundus in a circular motion with one hand while supporting the back with the other hand
D.
Rub the fundus vigorously with one hand until it becomes hard and expels clots
The correct answer and Explanation is :
Correct Answer: A. Use one hand to stabilize the lower uterine segment while massaging the fundus with the other hand.
Explanation:
Uterine atony is a leading cause of postpartum hemorrhage, where the uterus fails to contract adequately after childbirth. This lack of contraction causes excessive bleeding because the blood vessels at the placental site do not constrict properly. Fundal massage is a critical nursing intervention to stimulate uterine contractions, thereby helping to control bleeding and prevent hemorrhage.
In performing fundal massage, the nurse must follow specific techniques to avoid potential harm. The correct technique involves using one hand to stabilize the lower uterine segment near the pubic bone, while massaging the fundus with the other hand. This is necessary because, without stabilization, excessive pressure applied to the fundus could lead to uterine prolapse or inversion, a serious complication where the uterus turns inside out.
Here’s why other options are incorrect:
- B. Apply firm pressure on the fundus with both hands is incorrect because applying pressure without stabilizing the lower uterine segment can cause the uterus to invert, leading to a medical emergency.
- C. Massage the fundus in a circular motion while supporting the back is not appropriate since the lower uterine segment, not the back, must be stabilized to prevent injury to the uterus.
- D. Rub the fundus vigorously until it expels clots is incorrect as vigorous rubbing can damage uterine tissues. The goal is to massage gently but firmly until the uterus becomes firm and contracted. While clots may be expelled, the focus is on contraction, not clot expulsion.
Proper fundal massage, using the correct technique, is vital in preventing postpartum hemorrhage, promoting uterine contraction, and ensuring the patient’s safety.