Question

A nurse is assessing the fundus in a postpartum woman and notes that the uterus is soft and spongy and is not firmly contracted. The nurse should prepare to implement which interventions? Select all that apply.

1. Massaging the uterus
2. Pushing gently on the uterus
3. Assisting the woman to urinate
4. Rechecking the uterus in 1 hour
5. Checking for a distended bladder
6. Calling the delivery room to schedule an abdominal hysterectomy

Answer 1

In the case of a soft and uncontracted uterus after childbirth, a nurse should massage the uterus, assist the woman to urinate, and check for a distended bladder as primary interventions. Other actions such as gently pushing on the uterus, waiting an hour without intervention, or scheduling an abdominal hysterectomy are not recommended immediate actions.

Step-by-step explanation:

When a postpartum woman has a soft and spongy uterus that is not contracting properly, a nurse should implement certain interventions to help facilitate uterine contractions and prevent complications such as postpartum hemorrhage. These interventions include:

1. Massaging the uterus: To stimulate contractions and help the uterus to firm up, which helps to prevent bleeding.
2. Assisting the woman to urinate: A full bladder can inhibit the uterus from contracting effectively, so helping the woman to empty her bladder can promote better uterine contractions.
3. Checking for a distended bladder: Because a distended bladder can interfere with uterine contractions, assessing for bladder fullness and providing appropriate interventions is necessary.

Gently pushing on the uterus is not recommended because it can lead to inversion of the uterus, a serious complication. Rechecking the uterus in 1 hour without implementing any interventions would not be a direct action to help the situation and could delay essential care. An abdominal hysterectomy is a drastic surgical intervention and would not be a first-line response to a soft and uncontracted uterus in the immediate postpartum period. Only if there was uncontrollable bleeding and other interventions had failed would such a surgery be considered. The administration of synthetic oxytocin, not listed but relevant in such cases, stimulates uterine contractions and could be used as well. Any retained placental fragments must be ruled out as they can inhibit uterine contractions and cause bleeding.