[snwflknurse]

I am working as a nurse tech in OB this summer caring for postpartum couplets. I am doing great so far with most of my duties, but am having trouble sometimes with fundal checks. Sometimes, especially on a larger patient, I have such a hard time feeling the fundus. I am so afraid of hurting the patient that I feel like I'm taking too long, or not pushing hard enough to really feel it. And the C-section moms are very tough b/c they are in such pain when I do those checks.

Any tips for a newbie like me? I have been working with a primary nurse and she is double checking me, and sometimes I'm still not feeling it in the right spot.

HELP! (and thanks!)

[RNnL&D]

I always start at the umbilicus and work up or down from there.

For discomfort, you're just going to have to accept that it will be uncomfortable for some Moms. With Csection Moms, I try to have them hit their PCA button before I check their fundus.

[MacNurse]

I found that it helped to stabilize the uterus at the base with the other hand.

[babyktchr]

I find laying the patient flat helps a lot, especially when they are on the fluffy side. Most times it makes that uterus sit I up and you don't have to mash so hard to find it. Fundal checks on c/s hurt, no doubt about it. I have them take a deep breath in and when I check, to breathe out. Don' t know if it helps, but it kinda distracts them enough to do what I need to.

[Dayray]

You cant be afraid to hurt them. I'm not saying that you nessasarily have to hurt them but if you cant feel it, push harder. Think of it this way, they came to your hospital because they want care, they know that not all of it will be comfortable but they still came becuse they want to be safe. If you don't do your job because you are afraid to hurt them you have done them a diseverice. If someone has to follow after you then the pateint will be more hurt because they have to have it done twice. Do your fundal checks carefuly but realize that sometimes it is going to hurt. You can appolagize after and all but a few pateints will understand that you did'nt mean to hurt them and be thankful for your care.

[mtnmom]

#1 make sure that a mom's pain is well controlled
#2 make sure that the patient understands the reason for the fundal checks, and what can happen if a uterus is not firm and where it should be - I always find that throurough explanations for anything I do will take me a long way
#3 if the patient is overweight, you may have to dig a bit, but any discomfort should be temporary. Again, explain why you have to do it
#4 for c/s, use your other hand to stablize -
#5 sometimes if you are having trouble finding it you can "walk" your fingers up & down from the umbilicus.

you will get it!

[NurseNora]

Having the bed very flat is the key. With a fluffy patient it is expecially important. And make sure she isn't holding her head up to watch what you are doing because that tenses the abdominal muscles.

Always have your other hand giving super pubic pressure. With all the stretching of the ligaments and other tissues, you can invert or prolapse the uterus without that second hand in place.

Once you've seen a post partum hemmorhage from retained clots, you'll be more willing to take the chance of causing the patint some discomfort to avoid a worse problem

[Spidey's mom]

We don't do fundal check on cesareans

Otherwise, I just start at the umbilicus and work down - laying down flat does help alot too. Watching the docs do fundal massage after delivery helped me too because they push really hard.

steph

[CarrieAnne]

If you support the uterus right above the pubic bone with one hand you can find the fundus with the other quit easily. The bladder should be empty because if it is not the uterus will be displaced to the left. As for the larger women, yeah, you do have to mash harder but they should be use to this fact now; and we cant very well let them bleed out, or have undetected uterine inversion because we dont want to hurt their feelings. By the time they get to PP you should just have to feel to check placement. If it is not firm, then you will need to massage.
And as for not checking c/s, why not!!!!! We had a woman dang near bleed to death after her c/s. She was evauluated, every thing was fine; then, 5 min later the family came out and said "there is blood at the foot of the bed." There was sooo much blood, it looked as though she passed 3 additional placentas. More times than not the uterus is nice and firm before the pt gets to RR. However it is ACOG that states we must assess fundal positon, bleeding and dsg assessment every 10 minutes for at least 1 full hour after c/s. Again, alot of times it is just a gentle touch to check for placement and firmness. If it is not right then you must massage, which causes more pain, but is necessary none the less.

[Spidey's mom]

Originally Posted by CarrieAnne

If you support the uterus right above the pubic bone with one hand you can find the fundus with the other quit easily. The bladder should be empty because if it is not the uterus will be displaced to the left. As for the larger women, yeah, you do have to mash harder but they should be use to this fact now; and we cant very well let them bleed out, or have undetected uterine inversion because we dont want to hurt their feelings. By the time they get to PP you should just have to feel to check placement. If it is not firm, then you will need to massage.
And as for not checking c/s, why not!!!!! We had a woman dang near bleed to death after her c/s. She was evauluated, every thing was fine; then, 5 min later the family came out and said "there is blood at the foot of the bed." There was sooo much blood, it looked as though she passed 3 additional placentas. More times than not the uterus is nice and firm before the pt gets to RR. However it is ACOG that states we must assess fundal positon, bleeding and dsg assessment every 10 minutes for at least 1 full hour after c/s. Again, alot of times it is just a gentle touch to check for placement and firmness. If it is not right then you must massage, which causes more pain, but is necessary none the less.

I don't get a cesarean mom until after Recovery, which is at least an hour so maybe that is why we don't massage the uterus. I'll have to ask the Recovery nurses . . .. we just don't massage due to the incision -

I had a cesarean and didn't get massaged either . . .

hmmmmm . . .

steph