At which of the following locations would the nurse expect to palpate the fundus of a primiparous client immediately after delivery of a neonate?
- Halfway between the umbilicus and the symphysis pubis.
- At the level of the umbilicus.
- Just below the level of the umbilicus.
- Above the level of the umbilicus.
The Correct Answer and Explanation is :
The correct answer is:
2. At the level of the umbilicus.
Explanation:
Immediately after delivery, the nurse would expect to palpate the fundus of a primiparous client (a woman who is giving birth for the first time) at the level of the umbilicus.
After childbirth, the uterus undergoes a process called involution, where it gradually returns to its pre-pregnancy size and shape. During the first few hours postpartum, the uterus remains contracted, but the fundus, which is the top portion of the uterus, is typically palpable at the level of the umbilicus.
In a primiparous woman, the uterine fundus is generally at the level of the umbilicus immediately after delivery, as the uterus has been stretched and expanded during pregnancy. This location of the fundus is considered normal within the first few hours postpartum.
Fundal Position Over Time:
- Immediately after delivery: The fundus is usually firm and at the level of the umbilicus or slightly below, depending on the extent of uterine contraction and the stage of involution.
- 12 hours postpartum: The fundus may be approximately 1 cm above the umbilicus.
- 24 hours postpartum: The fundus may begin to descend at a rate of about 1 cm per day.
Postpartum Assessment:
When assessing the fundus, the nurse checks for several factors:
- Firmness: A firm uterus helps prevent hemorrhage by ensuring that the blood vessels within the uterine walls remain constricted.
- Position: The nurse notes whether the fundus is midline or displaced laterally, which could indicate bladder distension or other issues.
- Height: The nurse palpates the height of the fundus to ensure it is in the expected position as the uterus contracts and shrinks after birth.
This assessment is crucial for monitoring the patient’s recovery and identifying potential complications, such as postpartum hemorrhage or uterine atony.