fundus checks

  1. 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 vaginal 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.

  2. Visit zacarias profile page

    About zacarias

    Joined: Oct '01; Posts: 1,352; Likes: 83
    RN; from US
    Specialty: 14 year(s) of experience in tele, stepdown/PCU, med/surg


  3. by   RNLaborNurse4U
    I don't remember being able to feel a fundus at all during nursing school!! So don't worry to much about honestly does take practice and experience. I have worked in L&D/postpartum for 1 1/2 yrs now, and noticed the more fundal checks I did, the better I got at it. Now it's a piece of cake.

    The most common mistake a student/new nurse makes is that you don't press down hard/far enough. This is especially true in patients with large amounts of abdominal tissue. Start palpating just above the umbilicus, and work your way down the abdomen towards the pubis. A newly delivered mother's uterus can usually be felt right about at the umbilicus. Each postpartum day, the fundus generally decreases in size by 1 fingerbreadth.

    Once you feel a couple of really firm and easy-to-find ones, you'll become more confident in searching for them. You do need to dig pretty deep for most of them, so don't be afraid to feel around!

    Sometimes when I have students on the floor, and I feel a really good fundus, I'll tell the patient "You have a really nice fundus , do you mind if I grab a couple of students?"

    They look at me weird, and then they usually say OK.

    Good luck, it will get easier!

  5. by   Jolie
    Well, pooh on any staff nurse who won't take 2 minutes to help you assess a patient! How are you supposed to "trust yourself and your judgement" on your second day? I have the utmost respect for students who demonstrate a true willingness to learn by admitting their limitations and asking for help. Is your instructor on the unit? If so, ask her to go with you to see your patient. Good luck!
  6. by   L&D.RN
    I can tell you haven't been at our hospital today if it is slowness that you liked, lol!! Sheesh. When it rains, it pours!
  7. by   indynurse
    Whenever I am precepting a new nurse who doesn't have any OB experience, I try to find out from the previous shift which moms have the best fundus. Some of the really small women have a fundus you can practically see before you even palpate for it. For the harder to find fundus, I will palpate first and then tell the newbie where to find it. After a few of these, I will make her assess the fundus first and then have her tell me where to find it. If you are ever in doubt about a fundus, get a second opinion. Maybe the fundus really is boggy. Maybe her bladder is full and her fundus is displaced to the side. And then again, maybe she is just "extra fluffy" and it is difficult to find. Don't be afraid of causing a little discomfort when you are checking. Explain to the pt why it is important for you to do what you do.
    Have the patient lying completely flat in the bed. I find it easiest to palpate the fundus that way. If the fundus is boggy, do not be afraid to massage it. I have never massaged a uterus from boggy to firm to atoney.
    Whenever you are in doubt, get a second opinion. It is hard to trust yourself and your judgement on day two. Where is your clinical instructor? If he or she is unavailable, find out who the nurse is who is ultimately responsible for that pt on that shift. If the student thinks one of my pts is boggy or bleeding heavy or doing anything "worrisome" I want to know about it and if the instructor can't go check on it with them right away, I want to do it.
    Whenever a student is caring for one of my pts, I try to sneak into the room before the student, introduce myself to the pt, let them know that a student will be taking care of them and if they have any problems or concerns to let me know. Sometimes, if I hear something in report about the pt that worries me, I will do a quick assessment. The clinical instructor takes her students around each morning and introduces the student to her patient's nurse. I make sure they know that if their (my) pt needs anything and the instructor is tied up with another student, the student can come and find me and I will help. I remember plenty of rude nurses from when I did my clinicals and did not appreciate the way they treated nursing students. I enjoy having students on the unit and find that they can be very willing volunteers when you need help with something like transferring a pt from the cart to the bed. We had a day a couple of years ago when things were going to down the tubes for two of our pts at the same time and the nursing students and their instructor pitched right in and kept things from getting even uglier.
    Originally posted by indynurse
    If you are ever in doubt about a fundus, get a second opinion.
    Ahhhh yes. I STILL do this sometimes!

  9. by   jdomep
    LOL they used to get 2 to check me cause I always shrunk back to almost normal by discharge and they never could believe it They'd be poking around too high - hee hee
    Last edit by jdomep on Feb 20, '03
  10. by   zacarias
    Originally posted by indynurse
    Some of the really small women have a fundus you can practically see before you even palpate for it. For the harder to find fundus, I will palpate first and then tell the newbie where to find it.
    Indy, thanks so much. Now one mother I had this week, I can tell she's a thin woman normally. She still has a distended abdomen postpartum and this may be a stupid question, where that distention ends, is that where the fundus is? Or is it extra maternal "padding"?
    I'm pretty sure I felt her fundness at 1cm below umbilicus yesterday with her foley in. Today it seemed like it was at the umbilicus or higher. Maybe her bladder was slightly full although she wasn't having any voiding problems. When I press down, I feel something firm below the skin and I assume that's the uterus, but like others said, it will take time for me to get comfortable at it. Of course I won't be working in OB so....

  11. by   mother/babyRN
    Ask one of the friendlier nurses you work with to actually take your hand and pretend it is her hand, and guide your hand to the fundus. After awhile it will become familiar to you. Also, you have to get used to vigorous massage or checks in some cases even with c/s patients....If someone is uncomfortable or interested in learning fundal checks, I will always ask them if I can take their hand and guide it to what I am feeling. I also teach the patients how to do it when I am teaching them what I am doing and why. It does assist them in alleviation of cramping and any sort of teaching is a good thing....You will be fine. It just takes a little while to feel comfortable at anything new. Pretty soon you will be teaching other nurses and students how to do it.
  12. by   mother/babyRN
    When you think you have found the fundus, which is just the name for the top of the uterus, rub it gently and if it firms up, you will know that you have found it. ( sounds obscene)...
  13. by   Inkling
    Thanks for the advice. Your thread has helped.
  14. by   NurseNora
    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.