A nurse is contributing to the plan of care for a client who has multiple sclerosis. Which of the following interventions should the nurse include to enhance the client's ability to perform self-care?

Assisting an immobile client onto a bedpan requires proper positioning techniques to maintain comfort, dignity, and skin integrity while preventing injury to both the client and nurse. Bedpan placement involves reducing friction, supporting body alignment, and facilitating normal elimination mechanics. Correct sequencing of actions ensures safe transfer onto the bedpan and promotes effective bowel or bladder emptying. Nursing care should also minimize pressure injury risk in clients with limited mobility.

Rationale:
A. Elevating the head of the bed is performed after the client is positioned on the bedpan because an upright or semi-sitting position promotes normal elimination through gravity and increased intra-abdominal pressure. Raising the head too early may make positioning the bedpan more difficult and uncomfortable. This step improves comfort and effectiveness of toileting once placement is complete.

B. Positioning the client on the bedpan occurs after the client has been turned onto their side. The bedpan is placed firmly against the buttocks while the client is side-lying, then the client is rolled back onto the pan. Proper placement ensures stability, comfort, and prevention of leakage or skin irritation.

C. Rolling the client onto their side allows safe insertion of the bedpan beneath the buttocks. Side-lying positioning minimizes friction and shear forces while providing easier access for accurate bedpan placement. This technique is especially important for immobile clients who cannot independently lift their hips.

D. Applying a small amount of powder to the buttocks is performed first to reduce friction and facilitate easier removal of the bedpan after use. Powder can also help decrease skin irritation and discomfort caused by moisture or prolonged pressure. Skin protection measures are important in immobile clients at risk for breakdown.

Postpartum assessment within the first 24–48 hours focuses on identifying early complications such as hemorrhage and infection. Mild temperature elevations can be expected due to breast engorgement or dehydration, but significant fever is abnormal and may indicate infection such as endometritis or wound infection. Nurses must differentiate normal physiological postpartum changes from signs that require urgent escalation. Early detection is critical to prevent systemic infection and sepsis.

Rationale:
A. Non-pitting bilateral peripheral edema is a common physiological finding in the postpartum period due to fluid shifts and mobilization of extracellular fluid accumulated during pregnancy. It is typically self-limiting and not indicative of infection or acute complications. Monitoring and reassurance are usually sufficient.

B. An oral temperature of 38.8°C (101.8°F) is abnormal and requires immediate reporting because it may indicate postpartum infection such as endometritis or mastitis. In conditions like Postpartum infection, fever at this level suggests a significant inflammatory or infectious process requiring prompt evaluation and treatment.

C. Scant lochia rubra at 24 hours postpartum is a normal finding. Early postpartum bleeding is expected to be bright red and gradually decrease over time. Scant amount indicates appropriate uterine involution and does not suggest complications.

D. A fundus located 2 cm below the umbilicus is an expected postpartum finding. The uterus typically descends approximately 1 cm per day after birth as involution occurs. This indicates normal uterine contraction and recovery.