A nurse on a postpartum unit is caring for a client.

Exhibits

For each finding, click to specify if the finding is consistent with uterine atony or infection. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row. (Note: Each column must have at least 1 response option selected)

Rationale:

A. Ham sandwich with milk: Ham is pork, which is strictly prohibited under kosher dietary laws. Additionally, meat and dairy cannot be consumed together in a kosher meal, making this choice doubly inappropriate for someone following kosher rules.

B. Shrimp salad and tomato soup with milk: Shellfish, including shrimp, are non-kosher because they lack fins and scales. Combining shrimp (non-kosher seafood) with dairy also violates kosher dietary principles, making this an unsuitable option.

C. Bacon and cheese quiche with milk: Bacon is pork and non-kosher, and mixing it with cheese violates the rule against combining meat and dairy. Even if the bacon were turkey-based, kosher observance would still require strict supervision and certification.

D. Scrambled eggs and toast with milk: Eggs, bread, and milk are all permissible under kosher law if prepared in accordance with kosher standards. This option avoids mixing meat and dairy and excludes non-kosher animals, making it suitable for a kosher diet.

Rationale:

• Minimize environmental stimuli for the client: The client is displaying signs of acute mania including hyperactivity, distractibility, pressured speech, and hallucinations. A low-stimulation environment helps reduce sensory overload, agitation, and impulsive behavior, promoting safety and stabilization in manic patients.
• Weigh the client each day: The client has poor nutritional intake and increased activity, increasing risk for weight loss. Daily weights allow nurses to monitor nutritional status and detect early signs of dehydration or malnutrition, which are common in manic episodes where the client neglects eating.
• Provide the client with high-calorie fluids every hour: Due to constant movement, poor oral intake, and elevated energy levels, clients in a manic state are at high risk for fluid and calorie deficits. Offering high-calorie fluids frequently supports hydration and nutrition without requiring the client to sit down for full meals, which they may be too distracted to do.

• Encourage the client to avoid napping during the day: This client has not slept for 2 days, which exacerbates mania and disorientation. Preventing napping would worsen sleep deprivation. Instead, the nurse should promote rest whenever possible to help regulate mood, decrease agitation, and improve cognition in manic clients.