Postpartum assessment at your hospitals

Thedreamer · Jun 29, 2007

Sounds like cutting corners to me.. its your lisence, check what you want. Theres always a slight chance that something is out of the norm, so I would always check and do a full head to toe.

Jolie, BSN · Jun 29, 2007

They are cutting corners, and running the risk of missing early s/s of complications in their patients. How unfortunate!

Please hold yourself to a higher standard, for the sake of your patients and your license.

NPinWCH · Jun 29, 2007

That's just plain risky. I had a C/S after a 2 day pit induction VBAC attempt with my second child and I had one serious postpartum bleed. Hgb dropped from 14 to 6 something. I was numb from my spinal so I had no way of knowing and the RN didn't check my fundus when I returned from PACU. I called out to the nurses station to tell them that I heard something running onto the floor, and I was pretty sure I knew what it was and so I BEGAN MY OWN UTERINE MASSAGE. I blacked out just as the nurse entered the room...So I personally always have and always will check a fundus. Childbirth is childbirth and uterine atony isn't a respecter of mode of delivery.

Breath sounds I do once a shift...some nurses I work with don't do it, though it is on our assessment form. They just write "not auscultated" in the blank. I'm not sure why it only takes an extra 30-45 seconds.

Cover yourself, do a FULL assessment.

rnin02 · Jun 30, 2007

I'm still finishing up orientation to postpartum...but I've been taught to do a full assessment. I was told to be a little more "gentle" on the c/s mom's fundus, but definitely to check it! I would do the full head to toe, like you learned in clinicals/school...and take great care of your patients!

OB Night Nurse · Jul 4, 2007

The fundus and lochia should always be checked by evry on-coming nurse. At our hsopital, we require a full head to to check every 12 shift (but not if someone is filling in for a partial shift- like for the last 4 hrs-- hope that makes sense).

I delivered my first child where I work. I can tell you now that there are some nurses who do full assessments and chart them as such and others who do NOT do full assessments and chart them anyway. I've never heard of a post-partum nurse not checking a fundus at least q 8 -12 hours.

My advice is to check the fundus and chart per hospital policy or more often if you think the patient warrants more checks. Same for the full assessment. If the other nurses are charting they are performing them and they do not, they're heading for trouble. Sooner or later it will come back to haunt them.

Elvish, BSN, DNP, RN, NP · Jul 4, 2007

I do at least one head-to-toe when I come on for my 12 hours. That way, I have a baseline assessment.

I have found painful hemorrhoids that I was told nothing about, nipples that were cracked and bleeding, and a few distended bladders. Maybe the other nurse forgot, maybe she didn't check. Who knows, but if you chart that everything's normal when it's NOT normal, you're held accountable should it hit the fan.

However, I have NEVER heard of people not doing fundal assessments on c/s moms. That's just negligent, IMO.

Cover yourself and check it all.

indigo · Jul 5, 2007

It makes sense to do a head-to-toe always so you have your baseline. Make that your practice. The only way to know a fundus is firm is to palpate it, otherwise I guess you're just hoping it's firm. Even if it is firm, assess the amount and character of the lochia. Be sure your pt doesn't have a full bladder first!