A nurse is admitting a client who has diabetic ketoacidosis. Which of the following types of continuous infusions should the nurse initiate?

A. Palms of the hands. In clients with dark skin, assessing for cyanosis is best done in areas where skin is lighter and blood vessels are more visible, such as the palms, soles, lips, mucous membranes, and conjunctiva. These sites provide clearer visual cues of decreased oxygenation.
B. Area of trauma. This area may show signs of bruising or inflammation, but it is not ideal for assessing cyanosis. Local changes in color may be due to injury, not systemic oxygenation.
C. Sacrum. The sacrum is typically assessed for pressure injuries, not for cyanosis. Its location and frequent pressure make it a less reliable site for detecting systemic color changes.
D. Shoulders. The shoulders are not reliable sites for detecting cyanosis, especially in individuals with darker skin, as color changes may be less apparent in more heavily pigmented or sun-exposed areas.

• Endometritis – This uterine infection is one of the most common postpartum complications, especially following cesarean delivery and prolonged rupture of membranes. It often presents with foul-smelling lochia, uterine tenderness, and systemic signs of infection like fever and leukocytosis. This client’s presentation, including foul-smelling lochia and a WBC of 33,000/mm³, strongly supports this diagnosis.
• Mastitis – Typically associated with localized breast pain, redness, swelling, and systemic symptoms like fever. While the client has nipple discomfort and firm breasts, these are common postpartum findings during milk let-down and do not meet the criteria for mastitis, especially without signs of inflammation or localized breast infection.
• Pulmonary embolism – A PE generally presents with sudden-onset chest pain, dyspnea, tachypnea, and hypoxia. This client’s oxygen saturation is normal, lung sounds are clear, and there is no respiratory distress, making PE unlikely.
• Postpartum hemorrhage – Hemorrhage would present with excessive vaginal bleeding, hypotension, tachycardia, and possibly uterine atony. This client’s uterus is firm, lochia is moderate (not heavy), and vital signs are stable, so hemorrhage is not supported by the data.
• Lochia assessment – Foul-smelling lochia is a classic indicator of uterine infection. It points to endometritis when found with other risk factors like cesarean birth, prolonged labor, and signs of systemic inflammation.
• Elevated white blood cell count – A postpartum WBC count may be mildly elevated, but a level of 33,000/mm³ suggests infection. When combined with clinical symptoms like uterine tenderness and malodorous discharge, it supports a diagnosis of endometritis.
• Firm uterus at 1 cm above umbilicus – This finding is expected on postpartum day 3 and indicates normal uterine involution. A firm uterus rules out uterine atony and is not specific to infection or hemorrhage.
• Moderate nipple discomfort – Breast fullness and nipple tenderness are common in breastfeeding mothers, especially in the early postpartum period. This discomfort alone does not indicate mastitis or any systemic infection.