A nurse on a postpartum caring for a client.

Exhibits

For each potential client finding, click to specify if the finding is expected or unexpected.

A) Ask the client to empty their bladder:
One of the first actions the nurse should take when the uterus is not firm (often referred to as uterine atony) is to ask the client to empty their bladder. A full bladder can interfere with uterine contraction and cause the uterus to be boggy or soft, which can lead to postpartum hemorrhage. Encouraging the client to void may help the uterus contract more effectively and reduce the risk of complications.

B) Perform fundal massage:
If the uterus is not firm, performing a fundal massage is essential. Fundal massage helps stimulate uterine contractions and helps the uterus contract to its normal size, reducing the risk of bleeding. It is a critical intervention in postpartum care to ensure that the uterus remains firm and does not become atonic, which can cause excessive blood loss.

C) Nothing, this is an expected finding:
A soft uterus (uterine atony) is not an expected finding 4 hours postpartum. A firm uterus is expected at this point to prevent hemorrhage. The nurse should take immediate action to address the issue of uterine atony, as failure to do so can lead to significant postpartum hemorrhage, a life-threatening complication.

D) Ambulate the client in the hallway:
Ambulation may be helpful later in the postpartum period to encourage circulation and prevent thromboembolism, but it is not a priority when the uterus is not firm. The first priority is to address uterine atony, and actions like emptying the bladder and massaging the fundus should be performed before ambulating the client.

E) Give pain medications:
While pain management is important, it is not the priority intervention when the uterus is not firm. The nurse must first address the cause of uterine atony (such as bladder distention) and stimulate uterine contractions via fundal massage to ensure that the uterus is firm and the client is not at risk for excessive bleeding. Pain medications can be given once the immediate uterine concerns have been addressed.

A) A postpartum individual can have lochia rubra at 5 weeks postpartum:
Lochia rubra is the first stage of lochia, consisting of bright red blood and tissue, and is typically seen in the first 3-4 days postpartum. By 5 weeks postpartum, the lochia should no longer be in the rubra phase, and the discharge should have progressed to lochia serosa or alba. If the client is still experiencing lochia rubra at 5 weeks, this could indicate a problem, such as retained placental tissue or infection, and requires further evaluation.

B) A postpartum individual should not have any lochia at 5 weeks postpartum:
While it is true that lochia should be minimal or absent by 5 weeks postpartum, it is not uncommon for some women to still experience small amounts of lochia, particularly in the form of lochia alba, which can last up to 6 weeks. The type of discharge should be assessed, and if the discharge is abnormal (such as foul-smelling or accompanied by other symptoms), the nurse should investigate further. However, some amount of discharge, especially lochia alba, can be normal at this stage.

C) A postpartum individual can have lochia serosa up to 6 weeks postpartum:
Lochia serosa, which is pinkish or brownish in color and consists of blood, mucus, and uterine tissue, usually occurs between 4 to 10 days postpartum. It is not typically seen at 5 weeks postpartum unless there is a delay in the normal progression of lochia stages. By 5 weeks postpartum, lochia serosa should have already transitioned to lochia alba, a whitish or yellowish discharge.

D) A postpartum individual can have lochia alba ranging from 10 to 14 days and up to weeks postpartum:
Lochia alba is the final stage of lochia and typically starts around 10–14 days postpartum, lasting up to 6 weeks in some women. It consists mainly of leukocytes, epithelial cells, and mucus, and it is usually white or yellowish in color. This type of discharge is normal in the later weeks postpartum, and its presence at 5 weeks is considered a normal finding as long as it is not accompanied by foul odor, significant odor, or other signs of infection.