A nurse is providing teaching to the guardians of a toddler about discipline techniques. Which of the following statements by the guardian indicates an understanding of the teaching?

Rationale:

A. Take mineral oil at bedtime: Mineral oil is not recommended for long-term use because it can interfere with absorption of fat-soluble vitamins and may lead to aspiration pneumonia, especially in older adults. Safer stool softeners or laxatives should be used for opioid-induced constipation.

B. Decrease insoluble fiber intake: Insoluble fiber, such as wheat bran, helps bulk the stool and promote bowel movements. Reducing fiber intake can worsen constipation rather than relieve it, especially in clients taking opioids.

C. Increase exercise activity: Regular physical activity stimulates peristalsis and helps prevent constipation. Movement is a key non-pharmacologic strategy to counteract the slowed gastrointestinal motility caused by opioids.

D. Drink 1.5 L of fluids each day: Although hydration is important, adults typically require around 2 to 3 liters of fluid daily unless contraindicated. Limiting intake to 1.5 L may be insufficient to support normal bowel function and soften stool.

Rationale for Correct Choices

• Endometritis: This uterine infection is common after cesarean delivery, especially with prolonged rupture of membranes. The client’s uterine tenderness, elevated fundus, boggy consistency, and foul-smelling lochia are hallmark signs of endometritis, making it the most likely diagnosis.
• Uterus and lochia: The presence of a tender uterus that is elevated above the umbilicus and only firms with massage, combined with dark, malodorous lochia, strongly suggests infection of the uterine lining. These findings point specifically to endometritis rather than general postpartum changes.

Rationale for Incorrect Choices

• Mastitis: Although the client reports heavy, warm breasts with nipple discomfort, there is no breast erythema, localized swelling, or high-grade fever typical of mastitis. These symptoms are likely due to engorgement related to lactation rather than infection.
• Pneumonia: The client’s respiratory assessment shows clear lungs with only slight basal changes common postoperatively. There are no signs of cough, sputum production, hypoxia, or respiratory distress, which makes pneumonia an unlikely cause of her symptoms.
• Fever: A temperature of 38.2°C is above normal, but mild postpartum fever can have various causes, including engorgement, dehydration, or early infection. Fever alone is not specific enough to confirm a diagnosis without targeted findings.
• WBC count: Although an elevated WBC of 33,000/mm³ raises concern, postpartum leukocytosis can be physiologic or related to many infections. It is not diagnostic of endometritis without more specific correlating signs like uterine tenderness and abnormal lochia.