A nurse on a postpartum unit is caring for a client. Exhibits Click to highlight the findings that require immediate follow-up. To deselect a finding, click on the finding again. Vital Signs: Postpartum day 3, 0815: Temperature 38.2° C (100.8° F) Heart rate 104/min Respiratory rate 18/min BP 108/70 mm Hg SaO2 97% on room air Nurses' Notes: Postpartum day 3, 0815: Client reports feeling unwell. Lung sounds clear but diminished in the bases. Client states breasts feel firm, heavy, and warm with moderate nipple discomfort while breastfeeding. Uterus firm at 1 cm above the umbilicus and tender to palpation. Fundus boggy but firmed with massage. Moderate amount of dark brown, foul-smelling lochia noted. Surgical incision well approximated with slight edema present; no redness or drainage noted. No bowel movement since birth, hypoactive bowel sounds. Diagnostic Results: Postpartum day 3,0900: Hemoglobin 11.1 g/dL (greater than 11 g/dL) WBC count 33,000/mm3 (5,000 to 10,000/mm3)

Rationale for Correct Findings: WBC count 33,000/mm³: A significantly elevated white blood cell count strongly suggests a serious postpartum infection such as endometritis or sepsis, especially in a client with additional risk factors like cesarean birth and prolonged rupture of membranes. Moderate amount of dark brown, foul-smelling lochia: Malodorous lochia is a hallmark sign of uterine infection. This finding, in conjunction with uterine tenderness and systemic symptoms, indicates likely endometritis. Client reports feeling unwell: A nonspecific but important early sign of infection or systemic compromise. This symptom, when paired with objective findings, warrants prompt clinical attention. Fundus boggy but firmed with massage, uterus tender to palpation: A boggy uterus suggests uterine atony, which increases hemorrhage risk. Although it responds to massage, it reflects poor uterine tone and requires monitoring. Tenderness supports the likelihood of endometritis, Temperature 38.2° C (100.8° F): A postpartum temperature above 38° C, particularly after 24 hours, is considered abnormal and may indicate infection, especially when supported by other abnormal findings. Rationale for Incorrect Findings: Respiratory rate 18/min is within acceptable limits and do not indicate an immediate respiratory or circulatory emergency. Surgical incision well approximated with slight edema; no redness or drainage: Minor swelling without other signs of infection (e.g., erythema, warmth, discharge) is expected and does not require urgent intervention. No bowel movement since birth, hypoactive bowel sounds: Bowel inactivity is common postpartum, especially after cesarean and general anesthesia. While this warrants monitoring, it is not a priority unless symptoms worsen. Lung sounds clear but diminished in the bases. This is commonly observed postpartum, especially following cesarean delivery under general anesthesia. It may be due to decreased mobility, shallow breathing, or atelectasis. While it is a point to monitor it is not urgent