A nurse is caring for a female client, age 36, in the postpartum unit following a scheduled cesarean birth 12 hours ago.

Complete the following sentence by using the lists of options.
The client is at greatest risk for developing

__________

as evidenced by the client’s

__________

.

The client is at greatest risk for developing Endometritis as evidenced by the client’s Lochia characteristics.

Rationale for correct answers:
Endometritis is a postpartum uterine infection commonly occurring after cesarean birth due to ascending bacterial contamination. The client’s foul-smelling lochia is a hallmark sign, indicating infection of the uterine lining. Normally, lochia is odorless and changes from red to serous and then to white over weeks postpartum. The elevated WBC count (18,000/mm³; normal 5,000–15,000/mm³) supports infection but is nonspecific. The firm uterine tone reduces likelihood of postpartum hemorrhage. Urinalysis positive for bacteria suggests UTI but does not explain uterine signs. Hence, lochia changes are the most direct indicator of endometritis.

Rationale for incorrect Response 1 answers:
Postpartum hemorrhage typically involves heavy bleeding, uterine atony, or a rapidly dropping hematocrit, none of which is reported here. Urinary tract infection is suggested by urinalysis but does not account for uterine tenderness or foul lochia. Deep vein thrombosis would present with limb swelling, pain, and possible fever but no uterine or lochia changes.

Rationale for incorrect Response 2 answers:
Urinalysis positive for bacteria points to UTI but not uterine infection. Elevated WBC count indicates infection or inflammation but lacks specificity for endometritis versus other infections. Uterine tone is firm here, making hemorrhage or uterine atony unlikely and less relevant to infection diagnosis.

Take home points:

• Endometritis often presents postpartum with foul-smelling lochia and elevated WBC.
• Foul-smelling lochia is a critical clinical sign distinguishing endometritis from other postpartum complications.
• Positive urinalysis suggests UTI, a separate postpartum infection that requires differentiation.
• Uterine tone helps rule out hemorrhage and guides diagnosis of infection versus atony.

Choice A rationale: Moderate fetal heart rate variability indicates a healthy autonomic nervous system response in the fetus, reflecting adequate oxygenation and neurologic function. Variability within moderate range (6-25 beats/min) suggests the fetus is not currently experiencing hypoxia or acidosis. This finding is reassuring and does not require urgent reporting as it reflects normal fetal well-being according to obstetrical monitoring standards.

Choice B rationale: Persistent headache unrelieved by acetaminophen in a pregnant client with elevated blood pressure is a significant symptom suggestive of worsening preeclampsia or impending eclampsia. Headache can result from cerebral vasospasm or edema and requires prompt evaluation as it indicates central nervous system involvement. Elevated blood pressure over 140/90 mm Hg plus headache raises concern for severe preeclampsia.

Choice C rationale: The heart rate of 98 beats/min is within normal adult range (60-100 bpm) and is not clinically concerning in this context. Tachycardia or bradycardia might warrant attention, but a heart rate under 100 in a stable client with no signs of distress is typical and not a reportable abnormality in isolation.

Choice D rationale: Edema, especially 2+ pitting in the lower extremities and hands, is common in pregnancy but circumorbital and hand edema preventing ring removal is concerning. It may indicate fluid retention due to endothelial dysfunction and capillary leakage seen in preeclampsia. Such edema suggests worsening vascular permeability and should be reported for timely management.

Choice E rationale: Blood pressure reading of 160/98 mm Hg is above the normal pregnancy threshold (less than 140/90 mm Hg) and qualifies as severe hypertension. Elevated blood pressure is a key diagnostic criterion for preeclampsia and increases risk for maternal and fetal complications including stroke, placental abruption, and fetal growth restriction, requiring immediate provider notification.

Choice F rationale: The fetal heart rate of 130 beats/min falls within the normal baseline range (110-160 bpm) with moderate variability, indicating no current fetal distress. This normal finding does not require urgent reporting as it reflects appropriate fetal status.

Choice G rationale: Irregular contractions without pattern or intensity are common and often represent Braxton Hicks contractions, especially near term. These do not typically indicate active labor or distress and do not require urgent reporting unless they become regular, painful, or accompanied by other concerning symptoms.

Choice H rationale: Negative ankle clonus reflects normal neurological function and absence of central nervous system hyperreflexia. Presence of clonus could suggest severe preeclampsia with neurological involvement; its absence is reassuring and not a reportable concern.

Choice I rationale: Patellar deep tendon reflexes at 2+ are normal on a scale of 0 to 4+. Hyperreflexia (3+ or 4+) could indicate neurologic irritability from preeclampsia. Normal reflexes suggest no current severe neurological involvement, so this does not warrant immediate reporting.