Samuel Merrit University Oaklands Hesi Maternity (Labor and Delivery)
Samuel Merrit University Oaklands Hesi Maternity (Labor and Delivery) ( 44 Questions)
The nurse is caring for a client who delivered 6 hours ago. Assessment findings reveal a boggy uterus that is displaced above and to the right of the umbilicus. Which action should the nurse take?
Encourage voiding:
While promoting voiding is essential to ensure the bladder isn't distended and causing the uterus to be displaced, this action alone might not resolve the issue of uterine atony.
Notify healthcare provider:
This is a critical step. Alerting the healthcare provider promptly is necessary because displaced and boggy uteruses often signal uterine atony, which may require immediate medical intervention.
Inspect the perineal pad:
Checking the perineal pad can give clues about the amount of lochia (postpartum vaginal discharge). However, in this scenario, the priority lies in addressing the potential uterine atony.
Monitor vital signs:
While it's important to monitor vital signs, especially in postpartum clients, the priority here is recognizing and managing the potential uterine atony.
Encourage voiding:
While promoting voiding is essential to ensure the bladder isn't distended and causing the uterus to be displaced, this action alone might not resolve the issue of uterine atony.
Notify healthcare provider:
This is a critical step. Alerting the healthcare provider promptly is necessary because displaced and boggy uteruses often signal uterine atony, which may require immediate medical intervention.
Inspect the perineal pad:
Checking the perineal pad can give clues about the amount of lochia (postpartum vaginal discharge). However, in this scenario, the priority lies in addressing the potential uterine atony.
Monitor vital signs:
While it's important to monitor vital signs, especially in postpartum clients, the priority here is recognizing and managing the potential uterine atony.