A client requests to have a copper intrauterine device (IUD) inserted for contraception. Which of the following should the nurse recognize as a contraindication to IUD insertion?

Rationale:

A. Contraction intensity increased by ambulation: True labor contractions typically intensify with walking or activity, as the uterus works to dilate and efface the cervix. If contractions strengthen with movement, it suggests active labor rather than false labor.

B. Presence of bloody show: Bloody show indicates cervical changes with effacement and dilation, which are signs of true labor. Its presence helps differentiate true labor from false labor.

C. Slow change in dilation and effacement: True labor is characterized by progressive cervical change. Slow or minimal change in dilation and effacement is more consistent with false labor, but the primary hallmark is the nature of contractions.

D. Intermittent, painless contractions: False labor (Braxton Hicks contractions) is usually irregular, intermittent, and painless or minimally uncomfortable. They do not cause consistent cervical change and often subside with rest or position changes, making this a key distinguishing feature.

Rationale:

A. Monitor the height and tone of the client's fundus: Assessing uterine fundus is essential postpartum, especially with signs of infection and moderate lochia. Monitoring for firmness, height, and consistency helps identify uterine atony or worsening infection, guiding timely interventions to prevent hemorrhage or complications.

B. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: Most antibiotics prescribed for postpartum infections, such as clindamycin, are considered compatible with breastfeeding. Advising formula feeding unnecessarily could disrupt breastfeeding without clinical justification.

C. Initiate contact precautions: Postpartum infections like endometritis or mastitis are generally not spread via contact in a hospital setting. Standard precautions, including hand hygiene, are sufficient unless a specific transmissible pathogen is identified.

D. Instruct the client to wash her hands before and after changing her perineal pad: Hand hygiene prevents the spread of infection and reduces the risk of secondary infections. Teaching proper handwashing is an essential standard precaution for clients with postpartum infections.

E. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab: Routine cultures of lochia are not indicated unless there is suspicion of an unusual pathogen or worsening infection. Assessment and empiric antibiotics are standard for postpartum endometritis based on clinical findings.

F. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Semi-Fowler’s positioning promotes uterine drainage, reduces stasis of lochia, and supports comfort. This position aids in preventing complications such as uterine infection or retention of lochia.

G. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic used to suppress preterm labor. It is not indicated for postpartum infection, uterine atony, or lochia management and is not appropriate in this scenario.