CEBU TECHNOLOGICAL UNIVERSITY

In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING

CLASSWORK FORMAT
LEVEL II CCMC-CN
AY 2020-2021

NAME: Dela Rosa, Mary Justine G. YEAR & SECTION: Level II – A

SUBJECT/AREA: Care of Mother and Child at Risk DATE: April 14, 2021

Module 5: Woman After Birth: Postpartum Complications

1. Formulate one (1) Nursing Diagnosis for the following disorders.

a.) Thromboembolic Disorders
Ineffective tissue perfusion related to vessel wall injury
b.) Puerperal Infection
Acute pain related to body response to causative pathogens
c.) Subinvolition of the Uterus
Fluid-volume deficit related to hemorrhage
d.) Mood Disorders
Unhealthy coping mechanisms related to situation crisis

2. Write the procedures for fundal massage with the rationale.

Fundal Massage Rationale

Preparation The uterus will only start to contract after the placenta
1. Check if the placenta has been delivered has been delivered. This will promote the prevention
successfully. of hemorrhage through forcing down remaining clots.

The massage will not be as gentle as a pat in the back.

2. Inform client about the massage and it’s It will require force and can induce pain and
implications. Include explaining possible pain discomfort. It is important to inform them beforehand
and discomfort for them to manage expectations and promote
cooperation.

Procedure
The firm pressure going down will promote removal
1. Immediately after delivery, it is necessary to
of any remaining clots and reduce the possibility of
exert firm pressure on the abdomen just above
hemorrhage.
the uterus
2. Immediately massage the fundus of the uterus
Blood clots will be expelled only after the uterus will
through the woman’s abdomen until the uterus
be firm and contracted
is contracted (firm).
3. Ensure a firm downward and inward motion of This motion and direction helps the uterus contract
massage to expel possible clots and expel blood and/or clots.

LEVEL II CCMC-CN 1
 CEBU TECHNOLOGICAL UNIVERSITY
In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING

The contracted uterus helps compress the blood

4. Check that the uterus is firm after uterine
vessels that were attached to the placenta and overall
massage is stopped. If the uterus is soft, repeat
helps in preventing hemorrhage. At the same time, the
massage.
contraction promotes expulsion of clots.

5. Instruct the woman on how the uterus should The massage can be done on her own, thus, learning
feel and how to perform uterine massage. about it is important and critical.

6. Teach the mother how to locate her uterus

through the abdominal wall and how to
massage it periodically to keep it contracted.
7. A properly contracted uterus feels like a
grapefruit, or any other suitable fruit, and
should be in the center of the abdomen.
Aftercare
1. Proceed to perineal care and examining the
birth canal.
2. Dispose used materials
3. Document relevant data about the massage
The location of the uterus is important to know to
apply pressure to the accurate area.
This is the ideal location of the uterus and will be
guided with the felt lumps during massage. Contracted
uterus is easy to detect because of its firm shape.
Delivery process does not stop with the massage,
further procedures to ensure maternal safety should be
done and documented.
Used materials for procedure must be disposed to
prevent cross contamination and further risk to client.
Document time, frequency, and duration of massage.
Include the secretions and expelled products. This is
done to ensure that the procedure is done properly to
aid continuity of care.

References:

The Fundal “Massage” - The Fayetteville Doulas. (2020, August 5). Retrieved April 14, 2021,
from The Fayetteville Doulas website: https://fayettevilledoulas.com/the-fundal-
massage/

. (n.d.). AMTSL practice checklist 1. Retrieved from

https://path.azureedge.net/media/documents/MCHN_AMTSL_video_skills_chklst.pdf

Pillitteri, Adele. Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing Family. 2003. Lippincott Williams & Wilkins (Philadelphia)

LEVEL II CCMC-CN 2