A nurse on a postpartum unit is caring for a client.

Exhibits

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Nurses' Notes

2hr postpartum:

Client is 2 hr postpartum following vaginal delivery. Client alert and oriented. Lungs clear to auscultation bilaterally. S1 S2 auscultated, no murmur. Abdomen soft, nontender. Uterus firm and midline, 1 cm below the umbilicus. Moderate amount of lochia rubra present on perineal pad.

24 hr postpartum:

Client alert and oriented. Lungs clear to auscultation bilaterally. S1,S2 auscultated, no murmur. Abdomen soft, nontender. Uterus boggy and midline, 2 cm below the umbilicus. Moderate amount of lochia rubra present on perineal pad, foul odor present.

Vital signs:

1 hr postpartum:

Temperature 37.5° C (99.5° F)

Heart rate 88/min

Respiratory rate 16/min

Blood pressure 118/78 mm Hg

24 hr postpartum:

Temperature 38.3° C (100.9° F)

Heart rate 105/min

Respiratory rate 18/min

Blood pressure 115/78 mm Hg

A) Right upper quadrant:
The right upper quadrant would not be the most appropriate place to auscultate the fetal heart rate in this scenario. In a vertex presentation with the fetal back on the left side, the best location for auscultation is typically along the fetal back, which is on the left side of the mother. The right upper quadrant would place you over the small parts of the fetus (limbs, hands, etc.), which generally would not be where the fetal heart rate is best heard.

B) Left upper quadrant:
The left upper quadrant is the most appropriate area to begin auscultation for this fetal heart rate (FHR) pattern. In this position, the fetal back is positioned towards the left side of the mother's abdomen, and the heart rate is typically heard most clearly over the back. The left upper quadrant would be over the fetal back, making it the best location to auscultate the FHR accurately.

C) Right lower quadrant:
The right lower quadrant would not be ideal for auscultating the fetal heart rate in this scenario. Since the fetal back is on the left side, the right lower quadrant would likely be over the fetal small parts (arms and legs), where the FHR would be harder to distinguish.

D) Left lower quadrant:
Although the left lower quadrant is on the left side of the mother, it's closer to the pelvic area and may be less effective for auscultating the fetal heart rate in this vertex presentation. It's more likely to be over the lower parts of the fetus, potentially interfering with accurate heart rate auscultation.

A) At the umbilicus:
After delivery, the fundus is typically located at or just below the umbilicus in the immediate postpartum period, but it will gradually descend over the next few days. By 8 hours postpartum, the fundus is often slightly below the umbilicus, not directly at the umbilicus. The fundus will continue to shrink in size and move downward toward the pelvic region as the uterus contracts and involutes.

B) At a non-palpable depth:
A fundus that is non-palpable is generally expected later in the postpartum period, typically by 10-14 days after delivery, as the uterus contracts and returns to its pre-pregnancy size. At 8 hours postpartum, the fundus is still palpable, generally just below the umbilicus, and should be evaluated for firmness and position.

C) Just above the symphysis pubis:
The fundus is usually higher than the symphysis pubis at 8 hours postpartum, as it is still in the process of descending from the higher position it occupied during pregnancy. It would be expected to be just below the umbilicus or about 1 to 2 finger widths below it. By the second or third day postpartum, the fundus begins to move lower toward the symphysis pubis as it continues to involute.

D) Just below the umbilicus:
Eight hours after delivery, the nurse should expect to palpate the fundus just below the umbilicus. This is a typical finding as the uterus begins to contract and shrink after the delivery of the placenta. The fundus will descend about 1-2 cm per day postpartum, so by 8 hours, it is usually just slightly below the level of the umbilicus.