A nurse is completing an incident report after a client fall. Which of the following competencies of Quality and Safety Education for Nurses is the nurse demonstrating?

Rationale:

A. Perform an ECG every 12 hr: Frequent ECGs are typically done during the acute phase to monitor for arrhythmias, but by day 3 post-MI, continuous or as-needed monitoring is more appropriate unless new symptoms occur.

B. Obtain a cardiac rehabilitation consultation: Early involvement of cardiac rehab supports gradual activity progression, lifestyle modification, and psychosocial support, improving long-term outcomes after MI.

C. Draw a troponin level every 4 hr: Troponin testing is most useful for diagnosing and trending damage during the first 24 hours; by day 3, levels have usually peaked and are declining.

D. Place the client in a supine position while resting: Supine positioning can increase cardiac workload; a semi-Fowler's position is preferred to reduce venous return and ease breathing.

Rationale for Correct Choice:

• Endometritis: The client's temperature of 38.2°C (100.8°F), foul-smelling lochia, and tender uterus are classic signs of this infection. The high WBC count of 33,000/mm3 further confirms the presence of a significant infection. The client's history of prolonged rupture of membranes and a cesarean section also increases the risk.
• Uterus and lochia assessment: The specific findings of a tender uterus and foul-smelling lochia are the most direct evidence of a uterine infection. The uterus is the primary site of infection in endometritis, and the lochia (postpartum vaginal discharge) reflects the state of the uterine lining.

Rationale for Incorrect Choices:

• Mastitis: While the client reports firm, warm, and tender breasts, mastitis is usually unilateral and accompanied by localized redness and systemic symptoms like fever. In this case, the fever and uterine findings point more toward uterine infection.
• Pneumonia: Lung sounds are clear but diminished; there are no crackles, wheezing, or other respiratory symptoms such as cough or shortness of breath that would indicate pneumonia. The primary infection source appears obstetric, not pulmonary.
• Lung sounds (breath assessment): Diminished breath sounds alone are insufficient to diagnose pneumonia. The client’s main indicators of infection involve the uterus and lochia rather than respiratory compromise.
• Breast and nipple changes: Though mild breast tenderness is noted, these findings do not account for the systemic symptoms and uterine signs, making mastitis less likely as the primary diagnosis.