A nurse is providing teaching to a client who has gastritis. Which of the following instructions should the nurse include in the teaching?

Rationale for Correct Choices:

• Endometritis: The client has systemic signs (feeling unwell, low-grade fever), elevated WBC count, and local uterine findings indicating infection. Endometritis is a common complication postpartum, especially after cesarean birth with membrane rupture exceeding 24 hours.
• Uterus and lochia assessment: The presence of a boggy, tender uterus and foul-smelling, dark brown lochia are classic signs of endometritis. These findings, in the setting of cesarean delivery and prolonged rupture of membranes, point to uterine infection as the primary concern.

Rationale for Incorrect Choices:

• Pneumonia: The client lacks hallmark signs of pneumonia, such as productive cough, abnormal sputum, or abnormal chest auscultation like crackles or wheezing. Normal respiratory rate and oxygenation further reduce the likelihood of a lower respiratory tract infection.
• Mastitis: Typically presents with unilateral breast pain, erythema, warmth, and systemic symptoms like high fever and malaise. The client’s symptoms are more consistent with engorgement, making mastitis an unlikely cause.
• Lung sounds: While lung sounds are diminished at the bases, they are otherwise clear, and the client has normal respiratory rate and oxygen saturation. These findings do not support a diagnosis of pneumonia and may simply reflect postoperative atelectasis or limited mobility.
• Breast and nipple changes: Breast fullness and nipple discomfort are expected during lactation and suggest engorgement rather than mastitis. There is no redness, localized heat, or severe pain reported.

A. Bowel movement 5 days ago: Constipation is a common side effect of morphine and should be addressed, but it is not immediately life-threatening and can be managed with laxatives or stool softeners.
B. Pupil diameter 6 mm: Pupil dilation is not a typical concern with morphine; miosis (constriction) is more commonly expected. While abnormal pupil size can indicate neurologic or drug-related issues, hypotension takes priority here.
C. Blood pressure 80/40 mm Hg: Hypotension is a serious adverse effect of morphine that may indicate circulatory depression. It requires immediate intervention to prevent inadequate organ perfusion and potential shock.
D. Urinary output 120 mL/4 hr: This output equals 30 mL/hr, which is within the expected minimum range. No immediate intervention is required, though continued monitoring is appropriate.