What is the immediate action for a client exhibiting boggy fundus and increasing lochia rubra postpartum?

In the situation presented with a boggy fundus and increasing lochia rubra postpartum, the most appropriate immediate action is to have the client empty her bladder and massage the fundus. A boggy fundus indicates uterine atony, which is a leading cause of postpartum hemorrhage. Massage of the fundus helps stimulate uterine contractions, promoting firming of the uterus and reducing bleeding.

Encouraging the client to breastfeed is important for various reasons, including promoting bonding and facilitating milk production, but it may not address the critical issue of uterine atony immediately.

While giving medication as prescribed, such as uterotonics, is essential in managing atony, it is not the first immediate action that can be taken while waiting for the medication to take effect.

Contacting the healthcare provider would be necessary if nursing interventions do not stabilize the client or in case of severe complications, but addressing the physical factors, such as bladder distention and uterine massage, is a priority in this scenario.

Therefore, the most effective immediate action involves two proactive measures: encouraging the client to empty her bladder, as a full bladder can prevent adequate uterine contraction, and vigorously massaging the fundus to promote uterine tone.