A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath."
You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action?
a. Call for help. c. Take her blood pressure.
b. Assess the fundus for firmness. d. Check the perineum for lacerations.
ANS: B
Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated. Assessing blood pressure is an important assessment with a bleeding patient; however, the top priority is to control the bleeding. If bleeding continues in the presence of a firm fundus, lacerations may be the cause.
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