Exhibits

The nurse has reviewed the client's chart.

Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.

The nurse recognizes that this client is

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due to

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.

Rationale for Correct Choices:

• At risk of hemorrhage: Signs of postpartum hemorrhage, including a boggy fundus, excessive bleeding (saturated pad within 15 minutes), and a drop in blood pressure. These are all indications of uterine atony, which is a major cause of postpartum hemorrhage.
• Boggy fundus with a shift to the right: A boggy fundus is a hallmark of uterine atony, where the uterus does not contract effectively to stop bleeding. The shift to the right suggests that the uterus is not in its optimal position, potentially due to retained products or a full bladder, both of which can worsen hemorrhage.

Rationale for Incorrect Choices:

• Moderate lochia rubra with small clots: Lochia rubra with small clots in the first few hours post-delivery is generally expected and not immediately concerning unless there is significant soaking of pads or foul-smelling discharge.
• At risk for infection: While the client does have a 4th-degree laceration, there are no signs of infection, such as fever, redness, swelling, or purulent discharge. The focus here should be on the risk of hemorrhage due to the clinical presentation.
• In pain: While the client reports mild pain (4/10), it is not the most critical issue at this stage. The client's condition is more concerning due to the signs of hemorrhage and uterine atony. Pain management is not an immediate priority compared to controlling blood loss.
• Genital tract trauma: The signs of hemorrhage, such as a boggy fundus and rapid bleeding, are more pressing at this point than the concern for genital tract trauma, as there is no indication of active infection or dehiscence at this time.

A. Almost all women at 28-weeks gestation have anemia: While anemia is common in pregnancy, it is not typical for all women to have it. The nurse should provide specific information relevant to the client’s current values rather than generalizing.

B. Plasma volume increases, making the blood count appear low: During pregnancy, plasma volume increases significantly, which can dilute the blood and result in a lower hemoglobin and hematocrit level, even though the client may not have true anemia. This is a normal physiological change and is known as "physiological anemia of pregnancy."

C. Increasing intake of protein might improve these values: Protein intake is important during pregnancy, but it primarily supports tissue growth and development rather than directly improving hemoglobin or hematocrit levels.

D. It might be necessary to take an iron supplement twice daily: The client’s values are not significantly low enough to automatically recommend twice-daily iron supplements. The nurse should first explain the normal physiological changes in pregnancy before suggesting supplementation.