A postpartum client develops a vulvar hematoma after vaginal delivery. Which nursing intervention should the nurse implement first?

A vulvar hematoma is a collection of blood in the loose areolar tissue of the vulva or vagina, typically resulting from vessel trauma during vaginal delivery. The primary concern is ongoing blood loss, which can lead to hypovolemic shock due to the capacity of this tissue to hold a large volume of blood. Immediate nursing priorities focus on hemorrhage control and frequent assessment.

Initial Intervention: Apply an ice pack to the perineum immediately. Cold therapy causes local vasoconstriction, which slows blood flow, limits hematoma expansion, and provides analgesia. This is the first-line, non-invasive measure.

Ongoing Monitoring and Care:

• Mark the hematoma border with a skin pen to objectively track any increase in size.
• Monitor vital signs frequently for signs of hypovolemia (tachycardia, hypotension).
• Assess and manage pain with prescribed analgesics after initiating cold therapy.
• Monitor urinary output; a large hematoma can cause urethral obstruction and urinary retention.
• If the hematoma continues to expand or the patient becomes hemodynamically unstable, prepare for surgical intervention such as incision and evacuation or arterial embolization.