Question

A nurse is assigned to provide care to a client in labor and will care for the client throughout labor and into the postpartum period. The nurse assists in developing a plan of care and determines that the priority assessment in the fourth stage of labor is which of the following?

a) assessing the uterine fundus and lochia
b) checking the mother's temperature
c) encouraging food and fluid intake
d) providing privacy for the parents and their newborn infant

Answer 1

The priority assessment in the fourth stage of labor is assessing the uterine fundus and lochia to prevent and manage postpartum hemorrhage and to ensure proper healing without complications.

Step-by-step explanation:

The priority assessment in the fourth stage of labor is assessing the uterine fundus and lochia. The fourth stage, not commonly recognized as a separate stage, refers to the immediate postpartum period following the delivery of the placenta. This stage is critical for preventing and managing postpartum hemorrhage, which is the leading cause of maternal mortality globally. Nurses monitor the firmness of the uterine fundus to ensure that the uterus is contracting effectively, which helps to compress blood vessels and prevent excessive bleeding.

Additionally, assessment of lochia provides information on the quantity, color, and consistency of vaginal discharge post-delivery, which reflects the process of healing and ensures that there are no complications such as retained placental fragments or infection.