A patient is in the immediate postpartum period after having delivered 9 pound. 14-ounce baby (4480 grams). iS 6. The patient is gravida 6, para 5. The nurse notices some new blood stains on the top sheets and discovers the patient lying in a pool of blood. The fundus is located above the umbilicus and is boggy. The bladder is not palpable. What would be the nurse's priority action?

A) 2 to 3 oz (60 to 90 mL):
To determine the appropriate amount of formula for this infant, first calculate the total fluid requirements for the day. The infant weighs 6 lb (2722 g), and newborns typically need 73 mL of fluid per pound of body weight per day.
6 lb × 73 mL = 438 mL of fluid required daily.
Since the infant is fed every 4 hours, this equates to approximately 6 feedings in a 24-hour period.
438 mL ÷ 6 feedings = 73 mL per feeding.
Converting this to ounces (since 1 oz = 30 mL), the infant would need about 2.5 oz per feeding. Therefore, 2 to 3 oz (60 to 90 mL) per feeding is appropriate to meet the infant's daily fluid needs.

B) 1 to 1.5 oz (30 to 45 mL):
This amount is insufficient for the infant’s daily fluid needs. At 1 to 1.5 oz per feeding, the total intake for the day would be only 180 to 270 mL, which is well below the required 438 mL. This could lead to dehydration and inadequate nourishment.

C) 4 to 5 oz (120 to 150 mL):
This amount is excessive for a 3-day-old infant. Newborns typically consume much smaller amounts at each feeding due to their smaller stomach capacity. Overfeeding could lead to discomfort and potential digestive issues.

D) 3 to 4 oz (90 to 120 mL):
While this range is closer to the required amount, it is still slightly too much for a 3-day-old infant. At this age, the recommended amount is closer to 2.5 oz per feeding, so 3 to 4 oz may be excessive and could contribute to overfeeding, which might be uncomfortable for the infant.

A) Massage the fundus:
The first priority in this situation is to massage the fundus to help control potential postpartum hemorrhage caused by uterine atony. A boggy fundus (soft and not firm) suggests that the uterus is not contracting effectively, which can lead to excessive bleeding. Massaging the fundus stimulates uterine contractions, which can help reduce bleeding by compressing the blood vessels that were supplying the placenta. The nurse should begin with this intervention immediately to address the most likely cause of the bleeding.

B) Take the patient's blood pressure:
While vital signs such as blood pressure are important for assessing shock or ongoing hemorrhage, massaging the fundus takes priority in this scenario to directly address the cause of the bleeding. Taking the blood pressure is not the most immediate intervention for this specific situation because the primary issue here is uterine atony, not hemodynamic instability (although it will need to be assessed shortly thereafter).

C) Start an IV:
Starting an IV may be important if there is significant blood loss, but it is not the first priority in this scenario. The nurse should first focus on stabilizing the uterus by massaging the fundus. IV access will become more critical if the bleeding is not controlled after the fundus is massaged and other interventions are required.

D) Have the patient empty her bladder:
While a full bladder can sometimes displace the uterus and cause it to be less effective at contracting, this is a secondary concern. The first priority is to address the uterine atony by massaging the fundus. Once the fundus is firm and bleeding is under control, the nurse can then consider having the patient empty her bladder to ensure it isn't interfering with the uterus' ability to contract.