Evaluation
Evaluation ( 5 Questions)
A nurse is assessing a client who had a vacuum-assisted vaginal delivery and is experiencing a postpartum hemorrhage.
Which of the following findings should alert the nurse to a possible laceration of the birth canal?
A boggy uterus with fundus above umbilicus suggests uterine atony, which is the most common cause of postpartum hemorrhage.
Uterine atony is the failure of the uterus to contract and retract after delivery, leading to bleeding from the placental site.
This indicates that the bleeding is from an arterial source, such as a laceration of the birth canal.
Fundal massage stimulates uterine contractions and may increase the blood flow from the laceration site.
Normal ranges for blood loss after vaginal delivery are up to 500 mL and after cesarean delivery are up to 1000 mL. Postpartum hemorrhage is defined as blood loss of more than 1000 mL or signs of hypovolemia within 24 hours of delivery.
A firm uterus with fundus at umbilicus indicates that the uterus is well contracted and not likely to be the source of bleeding.
A well-contracted uterus prevents excessive bleeding from the placental site.
Dark red bleeding that decreases with fundal massage suggests that the bleeding is from a venous source, such as a hematoma.
Fundal massage may help to compress the hematoma and reduce the bleeding.
This indicates that the bleeding is from an arterial source, such as a laceration of the birth canal.
Fundal massage stimulates uterine contractions and may increase the blood flow from the laceration site.
Choice A is wrong because a boggy uterus with fundus above umbilicus suggests uterine atony, which is the most common cause of postpartum hemorrhage.
Uterine atony is the failure of the uterus to contract and retract after delivery, leading to bleeding from the placental site.
Choice C is wrong because a firm uterus with fundus at umbilicus indicates that the uterus is well contracted and not likely to be the source of bleeding.
A well-contracted uterus prevents excessive bleeding from the placental site.
Choice D is wrong because dark red bleeding that decreases with fundal massage suggests that the bleeding is from a venous source, such as a hematoma.
Fundal massage may help to compress the hematoma and reduce the bleeding.
Normal ranges for blood loss after vaginal delivery are up to 500 mL and after cesarean delivery are up to 1000 mL. Postpartum hemorrhage is defined as blood loss of more than 1000 mL or signs of hypovolemia within 24 hours of delivery.