What should a nurse do first when assisting a client with a hypotonic uterus and excessive vaginal bleeding?

In the scenario involving a client with a hypotonic uterus and excessive vaginal bleeding, providing fundal massage is the most immediate and appropriate action. A hypotonic uterus, which is one that is not contracting effectively, can lead to inadequate uterine tone and increased risk of postpartum hemorrhage. Fundal massage stimulates uterine contractions, which can help to constrict the blood vessels in the uterus and thereby reduce bleeding.

By placing a hand on the fundus (top of the uterus) and applying gentle pressure, the nurse promotes uterine tone and encourages retraction of the uterine muscles. This intervention is crucial in managing bleeding before other measures, such as medications or notifying a healthcare provider, are implemented.

While notifying the healthcare provider, administering medications, and assessing vital signs are all important aspects of managing a patient in this situation, the priority in this case is to address the immediate risk of bleeding by performing fundal massage, thereby helping to stabilize the client’s condition.