A nurse is reinforcing teaching about laboratory testing with a client who is at 6 weeks of gestation.
Which of the following statements should the nurse include?

Rationale for correct condition Endometritis is a postpartum uterine infection, often following cesarean birth and prolonged rupture of membranes. It presents with a boggy, tender uterus, foul-smelling lochia, fever or chills, and malaise. This client’s symptoms—uterine tenderness, foul lochia, and systemic signs—are classic for endometritis. Bottle-feeding increases risk due to lack of uterine oxytocin stimulation. Early recognition is critical to prevent sepsis.

Rationale for correct actions Oxytocin promotes uterine contractions, aiding involution and reducing bacterial proliferation in retained lochia. A firm uterus also minimizes bleeding. Broad-spectrum antibiotics target polymicrobial pathogens common in endometritis, including Escherichia coli and anaerobes. Prompt antibiotic therapy reduces systemic spread and improves recovery.

Rationale for correct parameters Lochia characteristics reflect uterine healing; foul odor and increased volume suggest ongoing infection. Monitoring changes helps evaluate treatment response. Temperature is a key systemic marker of infection; decreasing fever indicates therapeutic effectiveness. Persistent fever may signal treatment failure or complications.

Rationale for incorrect conditions Urinary tract infection typically presents with dysuria, urgency, and suprapubic pain—not uterine tenderness or foul lochia. Deep vein thrombosis involves unilateral leg pain, swelling, and warmth, which are absent here. Engorgement causes breast discomfort, not systemic symptoms or uterine findings.

Rationale for incorrect actions Increased fluid intake supports general health but does not directly treat endometritis. Anticoagulants are used for thrombosis, not uterine infection. Ice packs relieve breast engorgement but are unrelated to uterine infection management.

Rationale for incorrect parameters Leg circumference is relevant for DVT, not uterine infection. Nipple integrity is important for breastfeeding issues, not applicable here. Bladder distention is not contributing to uterine tenderness or infection in this case.

Take home points

• Endometritis is a common postpartum infection, especially after cesarean birth and prolonged rupture of membranes.
• Key signs include uterine tenderness, foul-smelling lochia, and systemic symptoms like fever or chills.
• Management includes uterotonic agents and broad-spectrum antibiotics.
• Differentiate from UTI, DVT, and breast engorgement based on localized versus systemic findings.

Choice A rationale

Nonsteroidal anti-inflammatory drugs (NSAIDs) primarily exert their therapeutic effects through the inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. While they possess analgesic and anti-inflammatory properties that can alleviate pain and swelling associated with thrombophlebitis, NSAIDs do not directly prevent the formation of thrombi or address the underlying coagulopathy. Therefore, their administration is not a primary prophylactic measure against thrombophlebitis development.

Choice B rationale

Early and frequent ambulation promotes venous return by stimulating the calf muscle pump, which compresses deep veins and propels blood back towards the heart. This mechanical action counteracts venous stasis, a major component of Virchow's triad for thrombus formation. By maintaining blood flow velocity and preventing pooling in the lower extremities, ambulation significantly reduces the risk of deep vein thrombosis and subsequent thrombophlebitis.

Choice C rationale

Applying warm, moist packs to the lower legs can provide symptomatic relief by promoting vasodilation and improving local circulation, which may reduce pain and inflammation associated with existing thrombophlebitis. However, this intervention does not prevent the initial formation of a thrombus. In fact, vasodilation could theoretically increase blood flow to an area with an active clot, but it does not address the fundamental mechanisms of thrombogenesis, such as stasis or hypercoagulability.

Choice D rationale

Elastic stockings apply external graduated compression to the lower extremities, with the highest pressure at the ankle and gradually decreasing pressure proximally. This external pressure helps to reduce venous distention, increase venous blood flow velocity, and prevent the pooling of blood in the superficial and deep veins. By mitigating venous stasis, a critical factor in the pathogenesis of thrombophlebitis, elastic stockings effectively reduce the risk of thrombus formation.