A nurse is preparing to perform an abdominal assessment on a child. Identify the sequence the nurse should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

A. The client who has a chest tube to water seal: A chest tube to water seal is primarily used to drain air or fluid from the pleural space. While the client with a chest tube may experience electrolyte imbalances due to fluid loss, hypokalemia is not directly associated with this type of drainage system.
B. The client who has a nasogastric (NG) tube to suction: Clients with nasogastric tubes to suction may experience hypokalemia due to the loss of gastric contents, which contain potassium. Suctioning removes gastric secretions, including potassium, from the body, leading to the risk of electrolyte imbalances such as hypokalemia.
C. The client who has an indwelling urinary catheter to gravity drainage: Gravity drainage of urine via an indwelling urinary catheter does not typically lead to significant potassium loss. While urinary catheterization may carry a risk of electrolyte imbalances over time, it is not as directly associated with hypokalemia as suctioning gastric contents.
D. The client who has a tracheostomy tube attached to humidified oxygen: Humidified oxygen delivery through a tracheostomy tube does not directly affect potassium levels. While clients receiving oxygen therapy may have other respiratory-related issues, hypokalemia is not typically a concern related to this type of therapy.

A. Notify the client's provider: This option might be considered if there are signs of postpartum hemorrhage, such as excessive bleeding, signs of shock, or a boggy uterus that does not respond to massage. However, in this scenario, the fundus is midline and firm, which indicates appropriate uterine contraction. Therefore, notifying the provider at this point may not be necessary.
B. Encourage the client to empty her bladder: Encouraging the client to empty her bladder is always important in the postpartum period, as a full bladder can impede uterine contraction. However, the presence of lochia rubra and small clots along with a midline and firm fundus suggests that uterine involution is progressing well. While encouraging the client to empty her bladder is appropriate, it may not be the priority in this situation.
C. Increase the frequency of fundal massage immediately: Fundal massage is typically performed to promote uterine involution and prevent postpartum hemorrhage. However, in this scenario, the fundus is already midline and firm, indicating adequate contraction. Increasing the frequency of fundal massage unnecessarily could cause discomfort to the client and is not indicated based on the current assessment findings.
D. Document the findings and continue to monitor the client: This is the most appropriate action at this time. The presence of lochia rubra and small clots along with a midline and firm fundus suggests that the uterus is involuting properly. Documenting the findings allows for accurate documentation of the client's condition and continued monitoring for any changes or developments. If the client's condition changes or if there are signs of postpartum hemorrhage, further action, such as notifying the provider, can be taken.