A nurse is collecting data from a client who gave birth one week ago. Which of the following findings should the nurse identify as a manifestation of endometritis?

Choice A reason: While ice packs can help reduce swelling and discomfort, they are not essential for preventing infection.

Choice B reason: Sit on an inflatable donut to protect the perineum is incorrect, as this can increase pressure and blood flow to the perineum and delay healing. The nurse should advise the client to avoid sitting on hard or uneven surfaces and to use a pillow or a cushion for comfort.

Choice C reason: Perform hand hygiene before and after voiding is correct, as this can prevent contamination and infection of the perineal area. The nurse should instruct the client to wash their hands with soap and water or use an alcohol-based hand sanitizer before and after using the toilet.

Choice D reason: Blot the perineal area dry after voiding is correct, as this can keep the perineal area clean and dry and prevent irritation and infection. The nurse should instruct the client to use a clean, soft cloth or tissue and gently pat or blot the perineal area from front to back after voiding.

Choice E reason: Clean the perineal area from front to back is correct, as this can prevent bacteria from entering the vagina or urethra and causing infection. The nurse should instruct the client to use a peri-botle filled with warm water and squirt it over the perineal area from front to back after each voiding or bowel movement. The client should also change their perineal pad frequently and dispose of it properly.

Choice A reason: Amniotic fluid in the vaginal vault indicates that the membranes have ruptured, but this does not necessarily mean that the client is in labor. Some women may have a slow leak of amniotic fluid for hours or days before labor begins. Rupture of membranes also increases the risk of infection, so the nurse should monitor the client's temperature and fetal heart rate.

Choice B reason: Contractions every 3 to 4 minutes are a sign of labor, but they are not enough to confirm it. The nurse should also assess the duration and intensity of the contractions, as well as the client's response to them. Some women may have false labor contractions, also known as Braxton Hicks contractions, which are irregular, mild, and do not cause cervical changes.

Choice C reason: Pain just above the navel is not a typical sign of labor. It may indicate other problems, such as placental abruption, uterine rupture, or fetal distress. The nurse should report this finding to the nurse midwife and check for other signs of bleeding, shock, or fetal compromise.

Choice D reason: Cervical dilation is the most reliable indicator of labor. It means that the cervix is opening and thinning out to allow the passage of the fetus. The nurse should measure the cervical dilation in centimeters and document it along with the station and effacement of the cervix.