A nurse is caring for a client who has an abruptio placentae. Which of the following findings should the nurse expect?

Rationale:

• Monitor for elevated temperature: Epidural anesthesia can mask symptoms of infection such as chorioamnionitis. Monitoring temperature helps detect early signs of infection or epidural-related complications.
• Assess for urinary retention: Epidural anesthesia often causes loss of bladder sensation, increasing the risk for urinary retention. Regular assessments are needed to determine when catheterization is required.
• Assist the client with ambulation: After epidural anesthesia, lower limb motor function may be impaired. Ambulation is unsafe due to the risk of falls and injury; bedrest is generally advised until full motor function returns.
• Inform the client to expect drowsiness: Drowsiness is not a typical side effect of epidural anesthesia; it may indicate systemic absorption or another issue. Encouraging drowsiness may mask concerning symptoms that need prompt evaluation.
• Encourage the client to turn from side to side: Repositioning helps maintain optimal uteroplacental perfusion and prevents hypotension caused by vena cava compression from aortocaval syndrome.

Rationale:

A. “Use an electric razor when shaving while taking this medication.” Warfarin increases bleeding risk by inhibiting vitamin K–dependent clotting factors. Using an electric razor reduces the chance of cuts and bleeding during shaving, making this a critical safety teaching point.

B. “This medication can cause back pain” Back pain is not a common or expected side effect of warfarin. If a client on warfarin experiences unexplained back pain, it should be evaluated as it could indicate internal bleeding, but it is not typical enough to be part of routine teaching.

C. "Take the last dose of the day 1 hour before bedtime” Warfarin is usually taken once daily, preferably at the same time, but timing in relation to bedtime is not required. The key is consistency and regular INR monitoring to guide dosing.

D. “Avoid taking the medication with milk products” Unlike some antibiotics, warfarin’s absorption is not significantly affected by dairy. Dietary consistency with vitamin K is more important than avoiding milk, and milk products are not contraindicated.