A nurse is teaching a female client about personal hygiene. Which of the following client actions indicates an understanding of teaching?

Rationale for Correct Choice:

• Endometritis: The client's temperature of 38.2°C (100.8°F), foul-smelling lochia, and tender uterus are classic signs of this infection. The high WBC count of 33,000/mm3 further confirms the presence of a significant infection. The client's history of prolonged rupture of membranes and a cesarean section also increases the risk.
• Uterus and lochia assessment: The specific findings of a tender uterus and foul-smelling lochia are the most direct evidence of a uterine infection. The uterus is the primary site of infection in endometritis, and the lochia (postpartum vaginal discharge) reflects the state of the uterine lining.

Rationale for Incorrect Choices:

• Mastitis: While the client reports firm, warm, and tender breasts, mastitis is usually unilateral and accompanied by localized redness and systemic symptoms like fever. In this case, the fever and uterine findings point more toward uterine infection.
• Pneumonia: Lung sounds are clear but diminished; there are no crackles, wheezing, or other respiratory symptoms such as cough or shortness of breath that would indicate pneumonia. The primary infection source appears obstetric, not pulmonary.
• Lung sounds (breath assessment): Diminished breath sounds alone are insufficient to diagnose pneumonia. The client’s main indicators of infection involve the uterus and lochia rather than respiratory compromise.
• Breast and nipple changes: Though mild breast tenderness is noted, these findings do not account for the systemic symptoms and uterine signs, making mastitis less likely as the primary diagnosis.

Rationale:

A. Dietitian: A dietitian focuses on nutritional needs, which may be beneficial if the client has dietary concerns, but this does not directly address mobility issues related to lower extremity weakness.

B. Physical therapy: Physical therapists specialize in improving strength, balance, and mobility. A referral will help the client develop exercises and strategies to enhance function and reduce fall risk.

C. Case manager: A case manager coordinates healthcare services, but they do not directly provide rehabilitation for weakness. They may be involved later to arrange additional resources after therapy needs are determined.

D. Social services: Social services assist with psychosocial needs, financial support, and community resources, but they are not the primary referral for addressing physical mobility limitations.