A case manager is discussing discharge plans with a client who has alcohol use disorder. Which of the following statements should the case manager make?

A. Back pain: Back pain is not a hallmark finding of postpartum endometritis. While some discomfort may occur due to uterine involution or positioning during labor, infection of the endometrial lining typically presents with uterine tenderness rather than isolated back pain. It is more commonly associated with musculoskeletal strain or renal conditions.

B. Bradycardia: Endometritis is an infectious process, and the body’s response typically includes tachycardia rather than bradycardia due to fever and systemic inflammation. Bradycardia would be inconsistent with the expected physiological response to infection and may suggest an alternative or unrelated condition.

C. Agitation: Although severe infection or sepsis can lead to altered mental status, agitation is not a primary or early sign of postpartum endometritis. More common early findings include fever, uterine tenderness, foul-smelling lochia, and systemic signs of infection rather than behavioral or cognitive disturbances.

D. Chills: Chills are a classic systemic manifestation of infection and are commonly associated with postpartum endometritis. The infection of the uterine lining triggers an inflammatory response, leading to fever and chills as the body attempts to fight the invading pathogens. These findings often occur alongside uterine tenderness and foul-smelling lochia.

A. Apply anesthetic cream to the perineum every 4 hr around the clock: While topical anesthetic creams can provide pain relief, applying them routinely around the clock is unnecessary and may cause skin irritation or systemic absorption. Pain management should be symptom-driven and balanced with other interventions.

B. Encourage the use of witch hazel pads after cleansing the perineum: Witch hazel pads provide astringent and anti-inflammatory effects, reducing perineal discomfort, swelling, and irritation common in the immediate postpartum period. Applying them after perineal cleansing helps maintain hygiene and promotes healing while being safe and noninvasive.

C. Place the client in a prone position: Prone positioning is rarely used postpartum due to difficulty maintaining comfort, the presence of uterine involution, and limited benefit for perineal pain. Supine or semi-recumbent positions with supportive measures are typically preferred.

D. Recommend the use of a sitz bath one time each day: Sitz baths can relieve perineal pain by improving circulation and promoting relaxation. However, once-daily use may not provide sufficient relief; more frequent, short-duration sitz baths (2–3 times daily) are generally recommended. Relying on a single daily bath is less effective than other interventions.