A nurse is providing teaching about self-care to a client who is primigravid and at 9 weeks of gestation. Which of the following statements should the nurse include?

Rationale

• Diarrhea: Diarrhea is common in both ulcerative colitis and Crohn's disease because chronic inflammation disrupts absorption and increases motility. UC typically presents with bloody diarrhea, while Crohn’s can present with non-bloody, intermittent diarrhea. Diverticulitis more often presents with left-lower-quadrant pain and constipation rather than chronic diarrhea.

• Steatorrhea: Steatorrhea is strongly associated with Crohn’s disease due to small-bowel involvement leading to fat-malabsorption. UC affects only the colon and does not impair fat absorption, so steatorrhea is not expected. Diverticulitis is a localized colonic infection and does not interfere with digestion or absorption.

• Weight loss: Weight loss occurs in both UC and Crohn’s because chronic inflammation increases metabolic demand and reduces nutritional intake. Malabsorption in Crohn’s disease further contributes to weight loss severity. Weight loss is not typical in diverticulitis unless the condition is prolonged or severe, so it is not strongly associated.

• Anemia: Anemia appears in both UC and Crohn’s disease due to chronic blood loss, reduced intake, and inflammation-driven suppression of erythropoiesis. UC often causes iron-deficiency anemia from recurrent rectal bleeding. Crohn’s may also cause anemia due to B12 or iron malabsorption. Diverticulitis does not typically cause chronic anemia.

• Fever: Fever is a sign of active inflammation and can occur in UC, Crohn’s flares, and acute diverticulitis. UC and Crohn’s involve systemic inflammatory activity during exacerbations. Diverticulitis produces fever due to infection of the diverticulum, making fever consistent across all three in varying degrees.

A. Assess for bladder distention: A full bladder can prevent the uterus from contracting effectively, leading to a boggy fundus and increased risk of postpartum hemorrhage. Assessing and addressing bladder distention is the priority because it directly impacts uterine tone and hemorrhage prevention.

B. Apply supplemental oxygen via nonrebreather mask: Oxygen may be necessary if the client shows signs of hypoxia or shock, but it does not address the primary cause of a boggy uterus. The priority is to correct the underlying issue affecting uterine contraction.

C. Administer intramuscular methylergonovine: Methylergonovine is used to promote uterine contraction, but pharmacologic intervention should follow initial assessment to identify reversible causes such as bladder distention. Administering medication without assessment could overlook a correctable mechanical issue.

D. Analyze coagulation studies: Coagulation studies are important if bleeding persists or coagulopathy is suspected, but they are not the immediate priority in a client with a boggy fundus shortly after birth. Immediate interventions to promote uterine contraction take precedence.