fundus checks

[zacarias]

Hey all,

I'm a nursing student in OB rotations right now. So far I like the slowness of it; it's a nice break from the hellish med/surg floor I dealt with last quarter. I do have a concern though.

I'm not feeling confident about fundus checks at all. My first patient was Cesarean and her uterus was almost impossible for me to feel. Today I had a lady partsl PP patient and I was pretty sure it was one fingerbreadth below the umbilicus, but wasn't quite sure. Next time I checked I didn't really feel anything. I tried to watch to see if I saw blood come out massaging it but saw nothing. Then I was worried about massaging it and causing atony. Anyway, you can see that I'm frustrated. If I ask the nurses, they think it's strange or they say, "trust yourself, trust your judgment." Does this just take time? Thanks guys.

Zach

[NurseNora, BSN, RN]

When you have trouble feeling a fundus, make sure the head of the bed is completely flat. For some women, especially the fluffy ones, having it up even a little bit can make it harder to find the fundus. Even if your patient is post epidural narcotics and the head of the bed is to be up for 24hrs, you can flatten the bed long enough to palpate the fundus.

Head of bed all the way down.

Feel farther above the umbillicus

Feel to the left or right side.

Press over the bladder area and ask if that makes her feel the need to void.

Ask her to get up and empty her bladder and then try again.

Get help.

Those are my suggestions for finding it. As others have said, it gets easier with practice. Tincture of time is the answer to so many problems.