A nurse is caring for a client who has an acute exacerbation of chronic pain. Which of the following medications should the nurse anticipate administering for the client?

Rationale:

A. WBC count: The client’s WBC decreased from 33,000/mm³ on postpartum day 3 to 10,000/mm³ on day 5, indicating resolution of the infection and an appropriate response to antibiotic therapy. This reflects improvement in the client’s inflammatory and immune status.

B. Fundal height: The fundus has descended from 1 cm above the umbilicus to 4 cm below the umbilicus and remains firm and midline, demonstrating normal uterine involution and a return toward pre-pregnancy size, indicating recovery from postpartum changes.

C. Temperature: The client’s temperature decreased from 38.6° C on day 3 to 37.1° C on day 5, showing resolution of the febrile response associated with infection and stabilization of her overall condition.

D. Lochia: The lochia changed from moderate, dark brown, foul-smelling on day 3 to a small amount of brownish-red, odorless lochia on day 5, reflecting improvement in uterine healing and the absence of ongoing infection.

E. Hgb: The client’s hemoglobin decreased slightly from 11.1 g/dL to 10 g/dL. While slightly lower, it remains above critical levels and is not an indicator of improvement; in fact, it shows a mild drop, likely from blood loss during delivery, so it is not considered a sign of recovery.

F. Heart rate: The client’s heart rate decreased from 110/min on day 3 to 78/min on day 5, indicating resolution of tachycardia associated with infection, pain, or stress, and reflecting stabilization of cardiovascular status.

Rationale for Correct Choices

• Endometritis: This uterine infection is common after cesarean delivery, especially with prolonged rupture of membranes. The client’s uterine tenderness, elevated fundus, boggy consistency, and foul-smelling lochia are hallmark signs of endometritis, making it the most likely diagnosis.
• Uterus and lochia: The presence of a tender uterus that is elevated above the umbilicus and only firms with massage, combined with dark, malodorous lochia, strongly suggests infection of the uterine lining. These findings point specifically to endometritis rather than general postpartum changes.

Rationale for Incorrect Choices

• Mastitis: Although the client reports heavy, warm breasts with nipple discomfort, there is no breast erythema, localized swelling, or high-grade fever typical of mastitis. These symptoms are likely due to engorgement related to lactation rather than infection.
• Pneumonia: The client’s respiratory assessment shows clear lungs with only slight basal changes common postoperatively. There are no signs of cough, sputum production, hypoxia, or respiratory distress, which makes pneumonia an unlikely cause of her symptoms.
• Fever: A temperature of 38.2°C is above normal, but mild postpartum fever can have various causes, including engorgement, dehydration, or early infection. Fever alone is not specific enough to confirm a diagnosis without targeted findings.
• WBC count: Although an elevated WBC of 33,000/mm³ raises concern, postpartum leukocytosis can be physiologic or related to many infections. It is not diagnostic of endometritis without more specific correlating signs like uterine tenderness and abnormal lochia.