What nursing interventions should be performed during uterine Fundus Examination after post partum?

PGIMER Sangrur NO - 2023

Obstetrics & Gynaecology

Medium

Appeared in: PGIMER Sangrur NO - 2023

Explanation

The primary nursing intervention for a soft, boggy uterus (uterine atony) is to perform fundal massage.
Massaging the fundus stimulates the uterine muscles to contract, which constricts blood vessels at the placental site and controls bleeding.
This is the most immediate and effective action to prevent or manage postpartum hemorrhage (PPH), a life-threatening complication.
The technique involves supporting the lower uterine segment with one hand while firmly massaging the fundus in a circular motion with the other.

Option B: While a full bladder can prevent uterine contraction, encouraging the client to void is a secondary action. The immediate, life-saving priority for a boggy uterus is to massage it to stimulate contraction.
Option C: Elevating the legs is an intervention for shock or hypotension. It does not treat the underlying cause of postpartum hemorrhage, which is uterine atony.
Option D: Pushing on a boggy, uncontracted uterus is extremely dangerous as it can cause uterine inversion, a medical emergency. This action is contraindicated.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Postpartum Nursing Interventions for Uterine Atony in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Uterine atony is the most common cause of PPH.
Nurses must be able to rapidly assess uterine tone and perform fundal massage correctly. This is a critical, life-saving skill in the immediate postpartum period.
What if? If the fundus is firm but located above the umbilicus and deviated to the right, the priority nursing action is to assist the client to empty her bladder. A distended bladder prevents the uterus from descending and remaining contracted.

How to Approach the Question

Identify the clinical scenario: The question asks for a nursing intervention during a postpartum fundal examination.
Recognize the implicit problem: The need for an intervention implies an abnormal finding. The most common and urgent abnormal finding is a boggy (soft) uterus, indicating uterine atony.
Analyze the options based on priority and safety. The goal is to stop potential hemorrhage.
Evaluate Option A (Massage): This directly addresses uterine atony by stimulating muscle contraction. This is a direct, causative treatment.
Evaluate Option B (Voiding): This addresses a possible contributing factor (full bladder) but is not the immediate solution for a boggy uterus.
Evaluate Option C (Elevate legs): This treats a potential symptom (shock) but not the cause (bleeding).

Concept Tested & Keywords

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 65-81, 4-9