Prior to performing a postpartum assessment, the client tells the nurse, "I have pain in my stitches." The nurse knows that the client had a midline episiotomy. Which action should the nurse take first?

A. Notify primary healthcare provider: The client is showing signs of postpartum hemorrhage, including a boggy fundus, significant blood loss, and a drop in blood pressure. Immediate communication with the healthcare provider is essential for further assessment and management.

B. Weigh all bloody materials: Weighing the pads and other bloody materials will provide a more accurate measure of the blood loss, which is crucial in assessing excessive bleeding. This will help guide further interventions and determine the severity of the hemorrhage.

C. Administer 2 units of packed red blood cells (PRBC): While the client’s hemoglobin and hematocrit are slightly low (11g/dL), immediate blood transfusion is not necessary unless the client shows signs of severe hypovolemia or shock. The focus should first be on stopping the hemorrhage.

D. Increase the IV fluid to maximum rate: The client’s IV fluid is already infusing at a rate of 125 mL/hr, which is appropriate for maintaining hydration. Increasing the IV rate may be helpful if the client shows signs of significant blood loss or shock.

E. Count saturated pads per hour: Monitoring the number of saturated pads per hour is critical to assessing the rate of bleeding. Excessive bleeding will help determine if interventions, such as administering medications or increasing fluids, are required to manage the hemorrhage effectively.

F. Insert straight catheter: The fundus is rotated to the right, which could indicate a full bladder, a common cause of uterine displacement and ineffective contractions. Inserting a straight catheter to empty the bladder can help reposition the uterus, improving contraction and reducing the risk of hemorrhage.

G. Alert the emergency response team: While the situation is concerning, the initial interventions should focus on managing the bleeding with appropriate steps like massaging the fundus and notifying the healthcare provider. Alerting the emergency response team may not be immediately necessary.

H. Administer 0.2 mg methylergonovine IM: Methylergonovine is used to manage uterine atony, but it is typically used when other interventions, like fundal massage, are ineffective. It is not the first intervention to try and should be used cautiously. The priority is to assess and stabilize the client.

I. Massage fundus until firm: The fundus is boggy, indicating uterine atony, which is a leading cause of postpartum hemorrhage. Massaging the fundus helps stimulate uterine contraction and is the first-line intervention for uterine atony.

A. When placental site has healed: While the healing of the placental site is important for overall postpartum recovery, menstruation typically resumes after other factors, such as hormonal changes, are regulated, and this is not directly tied to the healing of the site.

B. Four weeks after birth: It is uncommon for menstruation to resume just four weeks after birth. Most women, especially those who are not breastfeeding, may have their first postpartum period a bit later.

C. Six to eight weeks after birth: The typical time for menstruation to return is around six to eight weeks postpartum, although it may vary depending on the individual and whether the woman is breastfeeding or not. Non-breastfeeding women often resume menstruation sooner.

D. When ovulation resumes: Ovulation is a key factor in the return of menstruation, but it is not always directly tied to a specific timeline, and it can vary. For many women, menstruation resumes around six to eight weeks postpartum, although ovulation may occur earlier.