A nurse is delegating care of postpartum clients to a licensed vocational nurse (LVN). Which postpartum client is at the greatest risk for postpartum bleeding from uterine atony, and should not be delegated to an LVN's care?
1. A breastfeeding postpartum client
2. A postpartum client who began early ambulation
3. The client who delivered vaginally after a prolonged labor
4. A primiparous client
3
Rationale:
1. A breastfeeding client would be at less risk for postpartum hemorrhage, and would be appropriate to delegate to an LVN's care.
2. A postpartum client who ambulates early would be at less risk for postpartum hemorrhage, and would be appropriate to delegate to an LVN's care.
3. The client at greatest risk for postpartum hemorrhage because of uterine atony is the client who had a prolonged labor. Other factors that slow uterine involution and could interfere with contraction of the uterus during the postpartum period include anesthesia or excessive analgesia, difficult birth, grand multiparity, a full bladder, and incomplete expulsion of all of the placenta or fragments of the membranes.
4. A primiparous client would be at less risk for postpartum hemorrhage, and would be appropriate to delegate to an LVN's care.
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