A nurse is preparing discharge information for a client who has type 2 diabetes mellitus. Which of the following information resources should the nurse provide to the client?

Rationale:

A. "Place a pillow under your knees while in bed.": Elevating the knees with a pillow can compress blood vessels and restrict circulation, increasing the risk of venous stasis and deep vein thrombosis.

B. "Participate in range-of-motion exercises.": Performing range-of-motion exercises promotes blood flow in the extremities, prevents venous stasis, and reduces the risk of complications such as deep vein thrombosis, supporting postoperative circulation.

C. "Remain on bed rest for 24 hours following the procedure.": Prolonged immobility can impair circulation and increase the risk of blood clots. Early ambulation and movement are encouraged unless contraindicated by the provider.

D. "Use an incentive spirometer every hour”: While using an incentive spirometer is important for preventing respiratory complications, it primarily promotes lung expansion and does not directly enhance circulation.

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.