A nurse is educating a pregnant client about the differences between Braxton Hicks contractions and true labor contractions.
Which statement should the nurse include?

Choice A rationale

Thrombophlebitis, while a postpartum risk, is more commonly associated with factors like immobility, hypercoagulability of pregnancy, and cesarean birth. The immediate postpartum period after a vaginal birth is a lower risk time compared to later in the puerperium.

Choice B rationale

Puerperal infection typically manifests 24 hours or more postpartum, with signs like fever, uterine tenderness, and foul-smelling lochia. While the client is at risk in the coming days, it is not the immediate primary concern at 5 hours postpartum.

Choice C rationale

Retained placental fragments can lead to postpartum hemorrhage and infection, but the immediate risk after a vaginal birth of a large baby is more related to the uterus's ability to contract effectively. Signs would typically include persistent heavy bleeding.

Choice D rationale

Uterine atony, a failure of the uterus to contract adequately after birth, is a significant risk in the immediate postpartum period, especially following the delivery of a large infant (macrosomia). The overdistension of the uterus during pregnancy with a large fetus can impair its ability to contract firmly, leading to postpartum hemorrhage.

Choice A rationale

Monitoring vital signs (blood pressure, heart rate, respiratory rate, temperature) is a crucial immediate intervention to assess the client's hemodynamic stability in the presence of vaginal bleeding. Bright red bleeding may indicate active bleeding that could compromise maternal and fetal well-being.

Choice B rationale

While oxygen administration might be considered if there are signs of fetal distress or maternal hypoxemia, applying oxygen at 10L via non-rebreather face mask is not the immediate first-line intervention for painless bright red vaginal bleeding at 32 weeks gestation without further assessment. The need for oxygen depends on the overall clinical picture.

Choice C rationale

A digital vaginal examination is contraindicated in the presence of unexplained vaginal bleeding in the third trimester, especially if placenta previa is suspected. Palpation of the placenta could cause severe hemorrhage. An ultrasound should be performed first to determine the cause of the bleeding.

Choice D rationale

Initiating intravenous (IV) Lactated Ringers for fluid replacement is an important immediate intervention to maintain intravascular volume and prevent hypovolemia, especially if the vaginal bleeding is significant. This helps to support maternal circulation and fetal perfusion.

Choice E rationale

While assessing for domestic violence is important for the overall well-being of the pregnant client, it is not an immediate intervention in the acute presentation of painless bright red vaginal bleeding at 32 weeks gestation. The immediate focus should be on assessing and managing the bleeding and maternal-fetal status.