The practical nurse (PN) determines that a client who is one day postpartum has a moderate amount of lochia rubra and the uterus is firm, dextroverted, and three fingerbreadths above the umbilicus. Which should be the PN’s initial action?
A. Provide a stool softener for constipation.
B. Assess the bladder for distension.
C. Check the hemoglobin to determine uterine hemorrhage.
D. Massage the uterus to decrease atony.
The Correct Answer and Explanation is:
The correct answer is B. Assess the bladder for distension.
In this scenario, the client is one day postpartum, and her uterus is described as firm but dextroverted (tilted to one side) and positioned three fingerbreadths above the umbilicus. The normal position of the uterus after delivery should be midline and at or below the umbilicus. A firm uterus that is deviated from the midline and positioned higher than expected often indicates bladder distension. This is because a full bladder can push the uterus out of place, preventing it from properly contracting, which can lead to increased bleeding, also known as postpartum hemorrhage.
The first step for the practical nurse should be to assess the client’s bladder for distension, as bladder distension can inhibit uterine involution (the process by which the uterus returns to its pre-pregnancy size and position). If the bladder is distended, it should be emptied, either by encouraging the client to void or by catheterization if necessary. Once the bladder is emptied, the uterus should return to the correct position, and this will also help prevent excessive bleeding by allowing the uterus to contract effectively.
Option A, providing a stool softener, is unrelated to the immediate issue of uterine positioning and lochia management. Constipation is common postpartum, but it does not cause uterine displacement or affect bleeding in this scenario.
Option C, checking the hemoglobin, is important for assessing anemia or blood loss, but it is not the initial action in this situation. Hemoglobin levels are usually monitored postpartum, but first, the underlying cause of the potential issue—bladder distension—needs to be addressed.
Option D, massaging the uterus, is appropriate when the uterus is soft or “boggy” (indicating uterine atony), which is not the case here since the uterus is already described as firm. Massaging a firm uterus can cause unnecessary discomfort or injury.
In summary, the priority action is to assess for bladder distension and address it to prevent complications related to uterine displacement and postpartum hemorrhage.