Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

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.

A) Skin to Skin contact:
Skin-to-skin contact, also known as "kangaroo care," is a highly beneficial practice for both the mother and the infant in the immediate postpartum period. It promotes bonding by enhancing emotional connections, helps the infant maintain their body temperature through the transfer of warmth from the mother’s chest, and supports the initiation of breastfeeding, which is essential for the infant's nourishment. Additionally, skin-to-skin contact stimulates the release of oxytocin, which can aid in uterine contractions and promote involution of the uterus.

B) Swaddling the infant:
While swaddling the infant can provide comfort and a sense of security, it does not directly promote bonding or help with temperature regulation as effectively as skin-to-skin contact does. Swaddling can help the infant feel secure and prevent the startle reflex but does not have the same physiological benefits in terms of promoting involution or maintaining body temperature.

C) Allowing family members to hold the infant:
While allowing family members to hold the infant can help with bonding, it does not offer the same immediate physical benefits as skin-to-skin contact between the mother and infant. Skin-to-skin contact is particularly beneficial in terms of temperature regulation and promoting the early stages of breastfeeding, which can help with the involution of the uterus.

D) None of the above:
This option is incorrect because skin-to-skin contact has been shown to promote bonding, help regulate the infant's temperature, and support postpartum recovery processes, including uterine involution.