A nurse is assessing a client who is 6 hours postpartum and has endometritis. Which of the following findings should the nurse expect?

This is because a low pulse oximetry reading can indicate that the newborn is hypoxic and needs suctioning of the nasopharynx to clear any secretions that may be obstructing the airway²⁴. Hypoxia can cause bradycardia, acidosis, and brain injury in newborns, and should be corrected as soon as possible². The normal range of pulse oximetry for a newborn is 95% to 100%².

The other options are not correct because:
b) The newborn's respiratory rate is irregular
This is not a sign that suctioning is needed, as it is a normal finding in newborns. Newborns have periodic breathing patterns, which involve alternating periods of rapid and slow breathing, with occasional pauses of up to 10 seconds². This does not indicate respiratory distress or hypoxia, and does not require intervention unless the pauses are longer than 10 seconds or associated with cyanosis or bradycardia².
c) The newborn is beginning to cough
This is not a sign that suctioning is needed, as it is a normal reflex that helps the newborn clear the airway of secretions. Coughing can also stimulate breathing and prevent apnea in newborns². Coughing does not indicate respiratory distress or hypoxia, and does not require intervention unless it is persistent or associated with other signs of respiratory compromise².
d) The newborn's respiratory rate is 32/min
This is not a sign that suctioning is needed, as it is within the normal range for a newborn. The normal respiratory rate for a newborn is 30 to 60 breaths per minute². A respiratory rate that is too high or too low can indicate respiratory distress or hypoxia, and may require suctioning or other interventions².

Uterine atony is a condition in which the uterus does not contract properly after delivery, leading to excessive bleeding or postpartum hemorrhage. Uterine atony can be caused by various factors, such as

prolonged or fast labor, multiple gestation, large baby, polyhydramnios, infection, or use of certain medications¹.
The nurse should monitor the client for any signs of uterine atony, such as:
- A soft or boggy uterus that does not respond to massage
- Excessive bleeding or clots from the vagina
- Low blood pressure or fast pulse
- Pale or clammy skin
- Dizziness or fainting
The nurse should also provide immediate interventions to stop the bleeding and restore uterine tone, such
as:
- Massaging the uterus firmly until it contracts
- Administering uterotonic medications as ordered to stimulate uterine contractions
- Administering intravenous fluids and blood products as needed to replace blood loss
- Notifying the provider and preparing for possible surgical procedures if bleeding persists
Uterotonic medications are drugs that cause the uterus to contract and reduce bleeding. They are used to prevent or treat postpartum hemorrhage due to uterine atony. The most common uterotonic medications are:
- Oxytocin: a hormone that is naturally produced by the body during labor and breastfeeding. It is the first- line drug for uterine atony and is given intravenously or intramuscularly. It causes strong and sustained contractions of the uterus and also reduces blood pressure and pain. It has few side effects, but it can cause water retention, nausea, vomiting, or headache in high doses²³.
- Methylergonovine: a synthetic derivative of ergot, a fungus that grows on rye. It is a second-line drug for uterine atony and is given intramuscularly or orally. It causes prolonged contractions of the uterus and also constricts blood vessels in other parts of the body. It can cause side effects such as hypertension, headache, nausea, vomiting, chest pain, or allergic reactions. It is contraindicated in clients with hypertension, preeclampsia, cardiac disease, or liver disease²³.
- Carboprost: a synthetic form of prostaglandin F2 alpha, a hormone that regulates inflammation and blood clotting. It is a third-line drug for uterine atony and is given intramuscularly. It causes intense contractions of the uterus and also relaxes smooth muscles in other parts of the body. It can cause side effects such as fever, diarrhea, nausea, vomiting, bronchospasm, or allergic reactions. It is contraindicated in clients with asthma, liver disease, or kidney disease²³.
- Misoprostol: a synthetic form of prostaglandin E1, a hormone that protects the stomach lining from ulcers. It is an alternative drug for uterine atony and is given orally, rectally, sublingually, or vaginally. It causes mild to moderate contractions of the uterus and also dilates blood vessels in other parts of the body. It can cause side effects such as fever, chills, shivering, nausea, vomiting, diarrhea, or abdominal pain. It is contraindicated in clients with allergy to prostaglandins²³.
Therefore, the nurse should anticipate the use of methylergonovine for a client who has uterine atony that does not respond to oxytocin administration. The nurse should also monitor the client's blood pressure and vital signs closely and report any adverse reactions to the provider.

The other options are not medications that the nurse should anticipate the use of for uterine atony:
- a) Terbutaline is a medication that belongs to a class of drugs called beta-adrenergic agonists. It is used to relax the smooth muscles of the bronchi and uterus. It is used to treat asthma and preterm labor by preventing or stopping contractions. It is not indicated for uterine atony and can cause side effects such as tachycardia, palpitations, tremors, anxiety or hypotension²⁴.
- c) Hydralazine is a medication that belongs to a class of drugs called vasodilators. It is used to lower blood pressure by relaxing the smooth muscles of the arteries. It is used to treat hypertension and preeclampsia by reducing vascular resistance and improving blood flow. It is not indicated