PASCO HERNANDO STATE COLLEGE

MATERNAL/CHILD NURSING

CLIENT TEACHING PLAN

STUDENT NAME: Cherie Milburn CLIENT’S MEDICAL DX Postpartum NURSING DIAGNOSIS: Knowledge deficit regarding Fundal Massage r/t lack
of exposure to information

CLIENT’S INITIALS CJ AGE 38

LEARNING LEARNING CONTENT INSTRUCTIONAL EVALUATION OF

ASSESSMENT DATA OUTCOMES (In detail for each outcome specified & METHODS OUTCOMES
(3) Include supporting evidence)

Subjective Data: 1) Cognitive Fundal Massage Methods used by RN 1. Goal Met: The client has
“Am I supposed to bleed Client will fully p 460, 470, 472 (Lowdermilk, 2018) 1 Teaching client why fundus communicated full
this much? Is that amount understand necessity of 1. Explain to client why fundal massage needs to contract after birth understanding of fundal
of blood normal?” fundal massage and its is necessary to help the uterus stay facilitates client cooperation massage and its importance
firm 2. Demonstrating fundal massage AEB by verbal explanation of
“You want me to what? importance in preventing
2. Educate client on uterine involution ensures client sees correct how fundal massage
Massage my abdomen?” post-partum hemorrhage and its ability to contract and descend technique stimulates uterine
AEB verbalizing back to non-pregnant state 3. Written & verbal instructions on contractions prior to D/C
Objective Data: understanding the 3. Educate client on uterine contractions warning signs of post-partum
Blood loss heavy AEB importance of fundal prevents PP hemorrhage by hemorrhage and when to contact
one perineal pad saturated massage mechanical compression of the the nurse/provider
with 2 large clots in 45 intramyometrial blood vessels
minutes. 4. Fundal massages improves milk flow Implementation
& reduces stasis 1. Asses clients ability to learn
Uterus boggy on 5. Maintain a firm uterine at midline prior to teaching
2. Use therapeutic communication
palpation.
Interventions p 460, 470, 472 to establish a report with client
(Lowdermilk, 2018) (V. Laubach, 2019) 3. Explain physiological process of
BP: 95/60 1. Palpate fundus for location & tone involution & teach client to
T: 97.9 2. If fundus is atonic/boggy, gently assess & massage fundus
R: 24 massage and asses uterus response 4. Educate client on fundal
P: 110 3. Educate client on how to massage massage technique
Urinary output: 15mL/hr abdomen to stimulate contractions 5. Educate client on s/s of
Skin cool to touch 4. Assess I&O hemorrhage
5. Assess for full bladder 6. Evaluate clients learning by
6. Encourage client to void often having client explain reason for
7. Encourage early breastfeeding to fundal massage and its
release oxytocin promoting uterine importance
ctxs

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 8. Look for clot expression 7. Evaluate effectiveness of
9. Monitor lochia amount, color & smell education by observing client
10. Check underneath mothers buttocks perform fundal massage
and peripad to assess sheets for any
signs of bleeding
11. Observe/palpate fundus response to
massage
12. Observe for signs of pooled blood
after mother gets up out of bed
13. Assess clients color, capillary refill
and VS

2) Psychomotor Performing Fundal Massage Methods used by nurse 1. Goal Met: The client was
After observing the RN, (V. Laubach, 2019) (Lowdermilk, 2018) 1. Demonstrate fundal massage able to perform fundal
the client will slide 13, pg 470, 472 2. Explain how to perform fundal massage with 100% accuracy
demonstrate effective 1. Wash hands massage on day 1 post-delivery.
2. Apply gloves 3. Provide written material on
fundal massage AEB
3. Explain to the client what you are fundal massage
correct placement of doing the entire process
hands on fundus and 4. Explain to the client this may be very Implementation
technique of massage uncomfortable if not painful and 4. Asses clients ability to learn
prior to D/C reiterate its necessity prior to teaching
5. Palpate the fundus with dominate hand 5. Use therapeutic
cupping downward and press deep communication to establish a
until you feel it report with client
6. Explain how a contracting uterus will 6. Physical demonstration with
feel very firm from contacting and will verbal explanation of fundal
be midline massage
7. Support lower part of uterus while 7. Encourage the client to
massaging perform self-fundal massage
8. A soft uterus will feel soft or boggy, 8. Answer any questions the
this is called atony client may have regarding
9. Alleviate uterine atony by gentle fundal massage
stimulation until firm 8. Have the client perform a
10. Once the uterus is firm it should be fundal massage independently
midline 9. Confirm the clients ability to
11. Explain to the client she will have successfully perform a fundal
moderate to heavy bleeding the first massage
hour 10. Provide positive reinforcement
12. Explain that when she gets up for the on clients ability to perform
first time there may be pooled blood in fundal massage
the lower vaginal area, and this is a 11. Provide written instructions to
normal expectation her or significant other on D/C

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 13. Encourage the client to void often as a
full bladder interferes with uterine
contractions and deviates it from
midline
14. Encourage the client to breastfeed as
this releases oxytocin helping the
uterus to contract

3) Affective Feelings about fundal massage Methods used by nurse 1. Goal Met: The client
The client will feel 1. Fear r/t ability to perform effective 1. Discussion face to face openly addressed her fears
confident in own fundal massage 2. Use therapeutic communication and concerns in a
abilities to perform 2. fear r/t causing more bleeding or not to build report with client discussion afterwards and
decreasing the bleeding by not using 3. Use active listening techniques
fundal massage AEB stated she feels 100%
correct technique
open discussion of 3. anxiety r/t persistent bleeding Implementation
confident in her own
feelings relating to 4. anxiety r/t uterus not returning to pre- 1. Assess clients willingness to ability to perform fundal
anxieties and concerns birth state learn massage.
of fundal massage prior 2. Assess clients pain level as an
to D/C indication of whether the client
Validity of Feelings able to learn.
1. It’s normal to have feelings of anxiety 3. The nurse will discuss clients
with fundal massage if you’ve never feelings about fundal massage and
had to do this before offer support
2. Knowing methods to control bleeding 4. The nurse will actively listen to
and why these methods are effective the client by facing forward,
decreases fear leaning in and making eye contact
3. Knowing why your bleeding and how The nurse will address any
to control it decreases anxiety concerns
4. Understanding the uterus return to 5. The nurse will validate the
normalcy decreases anxiety as the clients feeling and encourage her
client knows what to expect to be an active participant in self-
care

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References
Lowdermilk, D. P. (2018). Maternal Child Nursing Care (6th ed..). In D. P. Lowdermilk, Maternal Child Nursing Care (6th ed..) (pp. 212, 311-312, 1329). St.
Louis, MO: Elsevier, Inc.
V. Laubach, E. M.-N. (2019, October). Postpartum Stage 4 Labor, PowerPoint presentation (slides 13, 47, 101)

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