A nurse is providing discharge teaching to the family of a client who has Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?

Rationale for Correct Choices:

• Intravenous antibiotic: The client exhibits signs of postpartum infection, most consistent with endometritis—elevated WBC count, low-grade fever, uterine tenderness, foul-smelling lochia, and a history of prolonged rupture of membranes and cesarean delivery. IV antibiotics are the first-line treatment to control uterine infection and prevent sepsis.
• Increase in daily fluid intake: Maintaining adequate hydration is essential to support tissue perfusion and aid in the clearance of infection. Fever and elevated WBCs increase metabolic demands, so increased fluid intake can help mitigate dehydration and support antibiotic therapy.

Rationale for Incorrect Choices:

• Kleihauer-Betke test: This test detects fetal-to-maternal hemorrhage, typically used after trauma or suspected placental abruption. It is not indicated in cases of suspected postpartum infection.
• Intrauterine tamponade balloon: This intervention is used for managing postpartum hemorrhage due to uterine atony or trauma, not infection. The client’s bleeding is moderate and not indicative of uncontrolled hemorrhage.
• Tocolytic medication: Tocolytics are used to suppress premature labor and have no role in postpartum care, especially in the presence of infection, where uterine relaxation could worsen outcomes.

A. “Morphine 3 mg subcutaneous every 4 hr PRN for pain.": This entry uses correct and safe medication documentation practices. It includes the drug name, dose without trailing zero, full route written out, frequency, and indication, reducing the risk of misinterpretation.
B. “Morphine 3 mg SC q 4 hr PRN for pain,": Abbreviations like “SC” and “q” are discouraged by The Joint Commission due to the potential for misreading. The full words "subcutaneous" and "every" are preferred for clarity and safety.
C. “Morphine 3.0 mg sub q every 4 hr PRN for pain.": The trailing zero (“3.0 mg”) increases the risk of dosage error if the decimal point is not seen. Safe practice omits trailing zeros in medication doses.
D. “Morphine 3 mg SQ every 4 hr PRN for pain.": The abbreviation “SQ” can be mistaken for “SL” (sublingual) or “5Q,” leading to errors. The route should be written out fully as “subcutaneous” to ensure clear communication.