A nurse is teaching a client who has migraine headaches how to use biofeedback to reduce the need for pharmacological interventions. Which of the fallowing information should the nurse include in the teaching?

Rationale for correct choices

• Temperature 38.2° C (100.8° F). An elevated temperature in a postpartum client may indicate infection, especially in the context of prolonged rupture of membranes and cesarean delivery. Prompt follow-up is required to identify the source and initiate treatment to prevent progression to sepsis.

• WBC count 33,000/mm³. A markedly elevated WBC suggests an active inflammatory or infectious process. In postpartum clients, leukocytosis can signal endometritis, mastitis, or surgical site infection, necessitating immediate assessment and intervention.

• Client reports feeling unwell. A general feeling of being ill or "not right" in a postpartum client with fever is a significant subjective finding often preceding more objective signs of infection/sepsis.

• Uterus firm at 1 cm above the umbillous and tender to palpation. Uterine tenderness combined with fever and foul-smelling lochia is a cardinal sign of endometritis (infection of the uterine lining), the most common postpartum infection, especially after Cesarean section.

• Moderate amount of dark brown, foul-smelling lochia. Foul-smelling lochia is a hallmark of uterine infection such as endometritis. Combined with fever and leukocytosis, this finding warrants urgent evaluation, monitoring, and possible initiation of antibiotics.

• Breasts firm, heavy, and warm with nipple discomfort. These signs are consistent with mastitis, particularly in a breastfeeding client. Early recognition and treatment with supportive measures or antibiotics prevent worsening infection and systemic involvement.

• Fundus boggy but firmed with massage. A boggy fundus indicates uterine atony, which can lead to postpartum hemorrhage. Immediate attention is required to prevent excessive blood loss and maintain hemodynamic stability.

Rationale for incorrect choices

• Vital signs: Heart rate while slightly elevated can be physiologic due to postpartum recovery, mild fever, or pain. Respiratory rate is within normal limits for adults; does not indicate acute compromise. Blood pressure is within normal postpartum range and does not signal hemodynamic instability at this time. Oxygen saturation is normal, indicating adequate oxygenation.

• Surgical incision well approximated with slight edema, no redness or drainage: Mild edema at the incision site is expected and not indicative of infection at this time. Regular monitoring is appropriate.

• No bowel movement since birth, hypoactive bowel sounds: Delayed bowel movements and hypoactive sounds are common postpartum, especially after cesarean section. Monitoring and supportive care are sufficient unless other symptoms develop.

Rationale:

A. Naloxone: Naloxone is an opioid antagonist used to reverse opioid overdose. It does not provide pain relief and is not appropriate for managing acute exacerbations of chronic pain.

B. Acetaminophen: Acetaminophen is useful for mild to moderate pain but may be insufficient for an acute exacerbation of chronic pain, especially if the client has severe or breakthrough pain.

C. Fentanyl: Fentanyl is a potent opioid analgesic appropriate for managing severe acute pain or acute exacerbations of chronic pain. It acts rapidly to relieve pain and is often used in clients already tolerant to opioids.

D. Zolpidem: Zolpidem is a sedative-hypnotic used to treat insomnia. It does not have analgesic properties and is not indicated for pain management.