Exhibits

For each potential assessment finding, click to specify if the finding is consistent with Crohn’s disease, appendicitis or intussusception. Each finding may support more than 1 disease process.

Rationale:

A. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: Most antibiotics, including clindamycin, are safe for breastfeeding. Mothers are encouraged to continue breastfeeding unless the medication is contraindicated, which it is not in this case.

B. Instruct the client to wash her hands before and after changing her perineal pad: Good perineal hygiene prevents spread of infection, particularly in clients with postpartum endometritis who are shedding infectious organisms in lochia. Handwashing is a key element in infection control.

C. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Semi-Fowler’s positioning promotes lochial drainage by using gravity, reducing the risk of retained secretions and supporting infection resolution.

D. Monitor the height and tone of the client's fundus: Fundal monitoring is essential for assessing uterine involution and identifying worsening atony or infection. A boggy uterus may indicate continued risk for hemorrhage or poor uterine tone.

E. Initiate contact precautions: Endometritis is not a condition requiring contact isolation unless there is evidence of another communicable infection (e.g., C. difficile). Standard precautions are sufficient.

F. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic that relaxes uterine muscle and is used to delay preterm labor. It is contraindicated postpartum and would worsen uterine atony.

G. Obtain a culture specimen of the lochia from the client's perineal pad using sterile swab: A lochia culture can identify the causative pathogen of suspected endometritis and guide antibiotic therapy if initial treatment is ineffective.

Rationale:

A. You should not delegate this task because it requires nursing judgment: Weighing clients is a routine, non-invasive task that does not involve clinical decision-making. It does not require nursing judgment and is appropriate for delegation if the AP is competent.

B. You can delegate this task to an AP for new clients before performing a nursing assessment: Initial assessments must be performed by a licensed nurse. Weighing can be part of the assessment, but the nurse should first evaluate the client to determine whether delegation is appropriate.

C. You can delegate this task if the AP has been trained to use our scales: Delegation depends on the AP’s competence and familiarity with facility equipment. If trained, the AP can safely and accurately weigh clients, freeing the nurse for tasks requiring professional judgment.

D. You should not delegate this task because you have the capability to obtain clients weights: Delegation decisions should be based on scope of practice and task appropriateness, not whether the nurse is physically able to perform the task. Efficient delegation supports safe and effective care delivery.