Student: Haley Patterson Faculty: NURS 2021

Topic: Maternal Assessment

Look Back: A meaningful event from my clinical experience is assessing the for a mothers

fundus postpartum independently. The nurse instructed me to preform fundal assessment to make

sure the mother’s fundus was firm and midline before getting discharged to go home with her

baby.

Elaborate: In first shift in maternal child, the charge nurse had demonstrated a fundal check

with me, and the patients fundus was deviated up and to the right upon palpation (vaginal birth).

The nurse told me to palpate for a ridge in the fundus, which I was able to feel for and was very

excited about it because I had only felt a simulated fundus in lab, and not on a human being. The

nurse informed me that her fundus was not as firm and midline because her bladder was full, and

we would check again before she was getting ready to be discharged, and after she had gone to

the bathroom to void. A couple hours later, the nurse instructed me to palpate her fundus for

firmness and that it was midline with her umbilicus so she could be discharged. Going into the

patients room I felt confident for the fundal check because I had gone through it with the nurse a

couple hours previous. However, I felt nervous that the patient or her partner would begin to ask

me questions that I couldn’t answer and get mad that a student was allowed to perform this

assessment/not able to answer their questions. I instructed the patient to lay in her bed, but was at

first unsure if the patients bed was to be completely horizontal for a proper fundal check, so I put

the head of the bed down just in case with the patient permission. I began to palpate the patients

upper abdomen because that is where the nurse had located it before, but couldn’t feel the

fundus. I then felt very unsure in myself and embarrassed that I couldn’t find the fundus because

both her and her partner were looking at me waiting for me to locate it. I explained to the patient

that it was my first day and I was having troubles finding the fundus. The patient directed me to
where the fundus was previously found by other nurses on her, and with that information I was

able to palpate the fundus. The patients fundus was firm and was midline and located 1

centimeter below the umbilicus, which I knew was normal for a mother who was one day

postpartum. I felt more at ease with the patient after she helped guide me, as she was very

understanding that it was only my first day and did not appear to be irritated that I did not palpate

for the fundus right away. I felt more confident in myself because I was after all able to feel for

the fundus after one day postpartum in the correct position which we had learned in lab the week

before. I was very excited that I was able to apply my theoretical knowledge which I learned in

lab, to a clinical setting with an actual postpartum patient. I also felt more confident I would be

able to locate the fundus more accurately the next time I preform a fundal assessment. After

preforming the assessment I told the charge nurse of the location and the firmness of the fundus.

Analysis: The key issue in this experience I had was that I did not stop and think before I

preformed the assessment of where the fundus anatomically should be one day after postpartum.

I also should have brought either the nurse or my preceptor into the patients room with me to

ensure I was doing the assessment correctly. I immediately assumed the patients fundus would

be in the same location it was when the nurse and I checked a couple hours previous, although I

knew it was pushed upwards and to the right because her bladder was full. What is known from

nursing theory is that normal findings within the postpartum fundal assessment is that the fundus

should be firm and central, either one centimeter above or below the umbilicus (Perinatal

Services BC, 2011). The fundus can feel boggy and obstructed by a full bladder (Perinatal

Services BC, 2011). I should have used my critical thinking during this assessment, especially

using my knowledge from lab and with the nurse that after a full bladder the fundus recedes back

to normal positioning. With the guidance of the patient, I was able to palpate the fundus in the
correct position. However I was embarrassed that I was not looking in the correct abdominal

location in which I should have been palpating in, and knew from theory in lab in which I should

have used while doing the assessment. During a postpartum assessment, the patient must be in a

supine position with the legs slightly bent, with the head of the bed flat, with one hand palpating

the fundus while the other stabilizes the uterus (Perinatal Services BC, 2011). The nurse must

also be looking at the lochia flow and colour while palpating for the fundus for signs of

postpartum hemorrhage which can be life threatening for the patient especially if not caught

early (Perinatal Services BC, 2011). These are to be done before palpation of the fundus to

correctly locate the fundus, and to make sure any other organs are not obscuring the location

(Perinatal Services BC, 2011). Looking back on the assessment I did for this patient, I did not

ensure all these were met. I did lower the head of the bed for the patient, but failed to support the

uterus with my other hand while looking at the lochia which is very important to assess for

postpartum hemorrhage (Potter & Perry 2014).

Revision: From this situation, it is important that I follow all the steps during a fundal assessment

because I am only learning and I am not an expert. I should have gotten the nurse or preceptor to

observe the assessment done on the patient to ensure patient safety and that I am correctly

preforming postpartum assessments. For the future, I would preserve my ability to admit to

patients that I am learning so we can help each other. However, I would change for next time to

stop and think about the anatomy of the body, and critically think about what I am doing and to

translate theory to practice. I would also ask that my assigned nurse or my preceptor shadow me

while preforming the assessment for optimal learning.

New Perspective: For future situations similar to this one, I will make sure to use my resources to

ensure I am hitting all the patient assessment requirements (ex. looking for lochia, supporting

uterus) before I go into the patients room. I will also call in the nurse or my preceptor to shadow

me in case I miss anything, or am unsure.

 References:

Perinatal Services BC. (2011). Obstetrics Guideline 20: Postpartum Nursing Care Pathway.
http://www.perinatalservicesbc.ca/Documents/Guidelines-
Standards/Maternal/PostpartumNursingCarePathway.pdf

Potter, P. A., Perry, A. G., Ross-Kerr, J. C., Wood, M. J., Astle, B., & Duggleby, W. (Eds.).
(2014). Canadian fundamentals of nursing (5th ed.). Toronto, ON: Elsevier. Chapter 31