A nurse is caring for a client who is 4 hours postpartum.

The nurse finds a small amount of lochia rubra on the client's perineal pad.

The fundus is midline and firm at the umbilicus.

Which of the following actions should the nurse take?

Choice A rationale

Providing a high-protein diet is beneficial for tissue repair and overall healing, as proteins are essential building blocks for cells and enzymes involved in the inflammatory and reparative processes. However, this intervention is secondary to addressing the underlying infection. Nutritional support optimizes recovery but does not directly eliminate the bacterial pathogen.

Choice B rationale

Encouraging weight-bearing on the affected limb is contraindicated in acute osteomyelitis. This action could exacerbate inflammation, increase pain, and potentially lead to pathological fractures or further dissemination of the infection within the bone, compromising structural integrity and delaying healing. Rest is crucial for minimizing stress on the compromised bone.

Choice C rationale

Administering IV antibiotics as prescribed is the priority intervention because osteomyelitis is a severe bacterial infection of the bone. Intravenous administration ensures high systemic concentrations of antibiotics, reaching the infected bone tissue efficiently to eradicate the pathogen, prevent further bone destruction, and reduce the risk of systemic complications like sepsis.

Choice D rationale

Applying heat packs to the affected area might provide some symptomatic relief from pain by increasing blood flow, but it is not a primary intervention for osteomyelitis. Heat can potentially increase swelling and may not be effective in reaching the deep-seated infection within the bone. Direct antimicrobial therapy is paramount for resolution.

Choice A rationale

Massaging the client's fundus is the immediate priority when a postpartum client saturates a perineal pad in 10 minutes, indicating excessive bleeding. Fundal massage stimulates uterine contractions, which compress blood vessels in the myometrium, reducing blood loss and preventing postpartum hemorrhage by promoting uterine involution and preventing atony.

Choice B rationale

Checking the client's blood pressure is an important assessment to monitor for signs of hypovolemia. However, it is not the first action. The immediate priority is to address the source of excessive bleeding and prevent further blood loss, which is achieved through fundal massage. Blood pressure assessment would follow.

Choice C rationale

Observing for pooling of blood under the buttocks is a necessary assessment to quantify blood loss and identify concealed hemorrhage. While important, it is a secondary action to fundal massage. The primary intervention focuses on controlling the bleeding at its source, as delaying can lead to rapid deterioration of the client's condition.

Choice D rationale

Administering oxytocin is a pharmacological intervention used to prevent and treat postpartum hemorrhage by increasing uterine contractility. While highly effective, it is not the *first* action. Manual fundal massage can be initiated immediately, providing a rapid mechanical stimulus to the uterus while awaiting medication preparation and administration.