A nurse is assessing a client who has endometritis. Which of the following findings should the nurse expect?

Rationale:

A. Oxytocin: Oxytocin is the first-line uterotonic used to manage postpartum hemorrhage by stimulating uterine contractions to reduce bleeding. It is safe for use in clients with preeclampsia and does not elevate blood pressure.

B. Methylergonovine: Methylergonovine is contraindicated in clients with preeclampsia or hypertension because it causes vasoconstriction, which can dangerously elevate blood pressure and increase the risk of stroke or seizure.

C. Carboprost: Although carboprost is effective for postpartum hemorrhage, it should be used cautiously in clients with hypertension. It can cause bronchospasm and elevate blood pressure, which may worsen preeclampsia symptoms.

D. Nifedipine: Nifedipine is a calcium channel blocker used for managing hypertension and preterm labor. It is not indicated for treating postpartum hemorrhage as it lacks uterotonic effects.

Rationale:

A. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: Most antibiotics, including clindamycin, are safe for breastfeeding. Mothers are encouraged to continue breastfeeding unless the medication is contraindicated, which it is not in this case.

B. Instruct the client to wash her hands before and after changing her perineal pad: Good perineal hygiene prevents spread of infection, particularly in clients with postpartum endometritis who are shedding infectious organisms in lochia. Handwashing is a key element in infection control.

C. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Semi-Fowler’s positioning promotes lochial drainage by using gravity, reducing the risk of retained secretions and supporting infection resolution.

D. Monitor the height and tone of the client's fundus: Fundal monitoring is essential for assessing uterine involution and identifying worsening atony or infection. A boggy uterus may indicate continued risk for hemorrhage or poor uterine tone.

E. Initiate contact precautions: Endometritis is not a condition requiring contact isolation unless there is evidence of another communicable infection (e.g., C. difficile). Standard precautions are sufficient.

F. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic that relaxes uterine muscle and is used to delay preterm labor. It is contraindicated postpartum and would worsen uterine atony.

G. Obtain a culture specimen of the lochia from the client's perineal pad using sterile swab: A lochia culture can identify the causative pathogen of suspected endometritis and guide antibiotic therapy if initial treatment is ineffective.