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

Exhibits

The nurse is continuing to care for the client. Which of the following actions should the nurse take? Select all that apply

Rationale:

A. Monitor the height and tone of the client’s fundus: The fundus is currently high 1 cm above the umbilicus and described as boggy (though it firmed with massage), suggesting subinvolution. Endometritis often interferes with involution, leading to a higher, softer (boggy) uterus. Frequent monitoring is necessary to check for hemorrhage and track the progress of the infection.

B. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic (used to stop contractions) and is contraindicated here. The nurse's goal is to ensure the uterus remains firm to control bleeding, not to relax it.

C. Encourage the client to maintain a semi-Fowler’s position to enhance uterine drainage: Positioning the client with the head of the bed elevated promotes drainage of lochia and exudate from the uterus via gravity, which can help prevent pooling and reduce the risk of ascending infection.

D. Initiate contact precautions: Postpartum endometritis is typically caused by normal flora ascending into the uterus (polymicrobial). It is not transmitted by contact and does not require contact precautions. Standard precautions are sufficient.

E. Instruct the client to wash her hands before and after changing her perineal pad: Crucial hygiene practice to prevent the spread of pathogens from the perineum to the upper reproductive tract and to others. Education on perineal care is always a priority.

F. Obtain a culture specimen of the lochia from the client’s perineal pad using a sterile swab: Obtaining a culture from an already used perineal pad would result in a heavily contaminated and uninformative specimen. Lochia cultures are generally not done routinely because lochia is always contaminated by vaginal and cervical flora. A blood culture is the most appropriate culture to identify the causative organism for endometritis, or an endometrial/intrauterine culture would be taken, but not from the perineal pad.

G. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: This instruction is incorrect and inappropriate. The necessity of stopping breastfeeding depends entirely on the specific antibiotic prescribed. Many antibiotics used to treat postpartum infection (e.g., clindamycin and gentamicin) are compatible with breastfeeding. The nurse should consult the provider and reliable drug resources before advising the client to stop breastfeeding.