A nurse is admitting a client who has diabetic ketoacidosis. Which of the following types of continuous infusions should the nurse initiate?

A. Request a prescription for terbutaline from the provider: Terbutaline is a beta-adrenergic agonist used to suppress uterine contractions in preterm labor. This client is postpartum with signs of uterine infection, and uterine involution and drainage are desired rather than uterine relaxation, making terbutaline inappropriate.

B. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab: The client demonstrates classic findings of postpartum endometritis, including fever, uterine tenderness, foul-smelling lochia, and leukocytosis. Obtaining a lochia culture supports identification of the causative organism and guides targeted antimicrobial therapy.

C. Initiate contact precautions: Postpartum endometritis is most often caused by polymicrobial vaginal flora and is not typically transmitted via direct contact. Standard precautions are sufficient, and contact isolation is not indicated in the absence of a highly transmissible pathogen.

D. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr.: Clindamycin is considered compatible with breastfeeding, and interruption of breastfeeding is not routinely required. Unnecessary cessation of breastfeeding can interfere with bonding and lactation without improving maternal or neonatal outcomes.

E. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Elevating the head of the bed promotes gravitational drainage of infected lochia from the uterus. This positioning helps reduce uterine distention, decreases bacterial proliferation, and supports resolution of uterine infection.

F. Instruct the client to wash her hands before and after changing her perineal pad: Proper hand hygiene reduces the spread of microorganisms and prevents reinfection or worsening of the existing uterine infection. This is a critical infection-control measure in postpartum clients with endometritis.

G. Monitor the height and tone of the client's fundus: Ongoing assessment of fundal height and tone helps evaluate uterine involution and response to therapy. A boggy or rising fundus may indicate uterine atony or retained products, which can worsen infection and increase hemorrhage risk.

A. Perform the Credés maneuver: The Credés maneuver involves applying manual pressure over the bladder to promote voiding. This technique is contraindicated in clients with continuous bladder irrigation post-TURP, as it can disrupt the surgical site and increase the risk of bleeding or trauma.

B. Maintain the irrigation solution rate: Pink-tinged urine is an expected finding in the immediate postoperative period following TURP. Maintaining the prescribed irrigation rate helps prevent catheter obstruction from clots, ensures continuous drainage, and reduces the risk of bladder distention and further bleeding.

C. Replace the indwelling urinary catheter: Catheter replacement is unnecessary when urine is draining and pink-tinged, indicating minor bleeding rather than obstruction or malfunction. Routine replacement could introduce infection and trauma.

D. Warm the irrigation solution: Warming the solution is generally not required unless the client experiences discomfort from cold fluid. It does not address the normal postoperative pink-tinged urine and does not influence clot prevention.