A nurse on a postpartum unit is caring for a client.

Exhibits

For each finding, click to specify if the finding is consistent with uterine atony or infection. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row. (Note: Each column must have at least 1 response option selected)

Rationale for Correct Choices:

• Temperature 38.2° C (100.8° F): Although a low-grade fever can occur postpartum, this temperature on day 3 combined with foul-smelling lochia and elevated WBCs raises concern for endometritis. The timing and associated findings shift the significance of this fever from physiologic to potentially infectious.
• Heart rate 104/min: Tachycardia postpartum may result from hypovolemia, infection, or pain. In this context, it supports systemic inflammation or early sepsis when paired with fever, uterine tenderness, and leukocytosis, and should not be dismissed.
• Client states breasts feel firm, heavy, and warm with moderate nipple discomfort while breastfeeding: These symptoms could reflect normal engorgement; however, when combined with systemic signs such as fever and malaise, they may also indicate early mastitis. Continued observation or early intervention may be needed to prevent progression.
• Uterus firm at 1 cm above the umbilicus and tender to palpation: Uterine tenderness, even if the uterus is firm, is an abnormal postpartum finding. It is often associated with endometritis, especially in clients with prolonged rupture of membranes and recent cesarean section.
• Fundus boggy but firmed with massage: A boggy uterus indicates uterine atony, a major cause of postpartum hemorrhage. Though it firmed with massage, its initial softness and the need for stimulation indicate ongoing risk and warrant further monitoring or intervention.
• Moderate amount of dark brown, foul-smelling lochia noted: Foul-smelling lochia is a hallmark of endometritis. The dark color and odor, especially beyond 48 hours postpartum, signal retained products or infection, which need urgent antibiotic treatment and further assessment.
• WBC count 33,000/mm³: A normal postpartum WBC count may rise to 14,000–16,000/mm³, but a value of 33,000/mm³ is markedly elevated. When accompanied by fever, malaise, and abnormal lochia, this strongly suggests infection or developing sepsis requiring immediate follow-up.

Rationale for Incorrect Choices:

• SaO₂ 97% on room air: Oxygen saturation of 97% is expected in a healthy postpartum client and indicates effective oxygen exchange. There is no indication of hypoxia, pulmonary embolism, or sepsis-related respiratory involvement with this reading.
• Surgical incision well approximated with slight edema present; no redness or drainage noted: A healing surgical incision without signs of erythema, discharge, or warmth is a reassuring finding. Mild edema can occur normally and is not indicative of wound infection or dehiscence in this context.
• Hemoglobin 11.1 g/dL (greater than 11 g/dL): Postpartum hemoglobin levels above 11 g/dL suggest the client is not experiencing significant anemia or blood loss. This level supports adequate oxygen-carrying capacity and does not indicate an acute obstetric complication.

Rationale:

A. Place the oxygen tank away from curtains or drapes: Oxygen supports combustion, so tanks must be kept away from flammable materials such as curtains or drapes. This placement reduces fire risk and ensures safe home oxygen use.

B. Store the oxygen tank wrench in a locked cabinet: The tank wrench should remain attached to or easily accessible near the tank for emergency shut-off. Locking it away could delay quick responses during equipment malfunction or fire hazards.

C. Ensure that the client checks the gauge weekly: Oxygen tank levels should be checked daily to prevent running out unexpectedly. Waiting a week between checks increases the risk of the tank depleting before a refill is arranged.

D. Have the client store smaller tanks under his bed: Storing tanks under the bed poses a fire hazard due to limited ventilation and proximity to bedding. Oxygen tanks should be stored upright in a secure, well-ventilated area away from heat sources.