A nurse is planning care prior to an amniocentesis for a client who is at 22 weeks of gestation. Which of the following actions should the nurse include in the plan of care?

Rationale for Correct Choices:

• Antibiotic prescription: The client is showing signs of a possible postoperative wound infection (fever, elevated WBC count, purulent discharge, tenderness), all of which warrant initiation of antibiotics to control local and systemic infection.
• WBC count: The WBC has increased significantly from 8,000/mm³ on day 1 to 14,800/mm³ by day 3, indicating a developing infectious or inflammatory process likely related to the surgical site.
• Temperature: The temperature has risen to 38.8°C (101.8°F) by day 3, suggesting a febrile response to infection, which aligns with the findings of purulent wound drainage and local tenderness.

Rationale for Incorrect Choices:

• Laxative: Although the client hasn’t had a bowel movement, this is expected early in the postoperative period, especially with hypoactive bowel sounds. Laxatives are contraindicated until full bowel function returns.
• IV fluids: There is no evidence of fluid volume deficit skin turgor is normal, and vital signs are stable making IV fluids unnecessary at this time.
• Prescription for IV iron: While hemoglobin is low, there is no evidence of acute blood loss, and infection is the more urgent concern. Iron supplementation would be a longer-term consideration.
• Bowel sounds: Hypoactive bowel sounds are common after abdominal surgery and not in themselves a reason to start antibiotics.
• Blood pressure: Client's BP is stable and within acceptable range; it does not indicate infection or require antibiotic treatment.
• Skin turgor: Normal skin turgor suggests hydration is adequate, not an indication for antibiotic use.
• Transferrin level: While slightly decreased, this is a nonspecific finding and not indicative of acute infection or requiring antibiotics.
• Bowel movements: Absence of bowel movement alone post-surgery does not justify antibiotics; infection indicators are more critical.

Rationale:

A. Heart rate: Initially elevated (110/min), the client’s heart rate has decreased to 78/min by postpartum day 5, reflecting hemodynamic stability and resolution of infection-related tachycardia.

B. Temperature: Fever present on day 3 (38.6°C) has resolved by day 5 (37.1°C), indicating improved systemic response and reduced inflammation or infection.

C. WBC count: Markedly elevated at 33,000/mm³ on day 3, consistent with postpartum endometritis, has normalized to 10,000/mm³ by day 5, suggesting resolution of infection.

D. Fundal height: Uterine involution is progressing appropriately, moving from 1 cm above the umbilicus to 4 cm below by day 5, indicating the uterus is returning to its non-pregnant state.

E. Lochia: Lochia has changed from moderate, foul-smelling, dark brown on day 3 to a small amount of brownish-red with no odor by day 5, showing improvement in uterine healing and decreased infection.

F. Hemoglobin: The client’s hemoglobin has dropped from 11.1 g/dL to 10 g/dL. While still near the normal postpartum range, this decline does not represent an improvement and may indicate mild ongoing blood loss or dilutional effect.