A public health nurse is planning strategies to address substance use for clients in the community. Which of the following strategies are part of primary health promotion and prevention?

A. Assess the client's peripheral pulses every 15 min. Frequent assessment of peripheral pulses, especially in the affected extremity, is essential to monitor for signs of arterial occlusion, hematoma, or compromised circulation following a femoral catheterization.

B. Change the client's dressing 4 hr following the procedure. The initial pressure dressing should not be disturbed unless there are signs of bleeding or saturation. Routine dressing changes this soon can disrupt the clotting process at the insertion site.

C. Instruct the client to flex the right knee every 30 min. The client should keep the affected leg straight to prevent disrupting the insertion site. Flexing the knee can increase the risk of bleeding and compromise the integrity of the puncture site.

D. Elevate the head of the client's bed to 45°. Elevating the head of the bed too high can increase abdominal pressure on the femoral site, risking bleeding. The bed should be kept no higher than 30° to reduce stress on the insertion area.

A. Request a prescription for terbutaline from the provider. Terbutaline is a tocolytic used to stop preterm labor, not indicated in this postpartum scenario. The client is already on uterotonic therapy (methylergonovine), which is appropriate for postpartum uterine atony.
B. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab is inappropriate because the pad is asceptic.

C. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr. This is incorrect. Breastfeeding is usually safe with most antibiotics, including clindamycin, and mothers with postpartum infections can typically continue breastfeeding unless advised otherwise by the provider.
D. Initiate contact precautions. Contact precautions are not necessary unless the client has an identified or suspected infection that is transmissible by direct contact (e.g., MRSA). Standard precautions are sufficient for routine postpartum care and suspected endometritis.
E. Monitor the height and tone of the client’s fundus. The fundus is tender and was initially boggy, indicating risk for uterine atony or subinvolution. Monitoring tone and height helps detect complications such as hemorrhage or infection.
F. Instruct the client to wash her hands before and after changing her perineal pad. Hand hygiene is essential to prevent the spread of infection to the perineal area or incision and to promote general postpartum hygiene.
G. Encourage the client to maintain a semi-Fowler’s position to enhance uterine drainage. This position helps promote lochia drainage, reduce uterine pooling, and may help with comfort and resolution of infection by improving uterine drainage.