A nurse is caring for a client who has an abruptio placentae. Which of the following findings should the nurse expect?

A. "My home has running water and electricity." This statement suggests adequate access to basic utilities, which supports hygiene and reduces risk for illness. It does not indicate a health risk.
B. "I eat vegetables directly from the field where I work." This poses a significant health risk due to potential pesticide exposure and contamination with harmful chemicals or microbes. Produce should be properly washed before consumption to reduce the risk of illness or poisoning.
C. "I wear a hat and long sleeves while I am working." This is a protective behavior, helping to reduce sun exposure, skin damage, and pesticide contact, and is not a health risk.
D. "I am currently sharing my home with two roommates." While crowded living conditions can pose some risk, this alone does not indicate a major health concern, especially if basic sanitation and ventilation are adequate.

• 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.