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 38.20 C (100.80 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)

Findings Requiring Immediate Follow-Up: Temperature 38.2 °C (100.8 °F): Fever in the postpartum period can indicate an infection such as endometritis or mastitis. Any temperature ≥100.4 °F (38 °C) after the first 24 hours postpartum warrants further evaluation. Client states breasts feel firm, heavy, and warm with moderate nipple discomfort while breastfeeding: These are signs of engorgement or mastitis, a localized breast infection. Warmth, firmness, and nipple discomfort, especially with fever, need prompt assessment to prevent systemic infection. Uterus firm at 1 cm above the umbilicus and tender to palpation: A tender, enlarged uterus suggests uterine infection or subinvolution, particularly in combination with foul-smelling lochia or fever. Requires immediate evaluation. Moderate amount of dark brown, foul-smelling lochia: Foul-smelling lochia is a classic sign of endometritis, which can become life-threatening if untreated. This finding in conjunction with fever and uterine tenderness is urgent. WBC count 33,000/mm³ (5,000 to 10,000/mm³): Marked leukocytosis indicates a systemic inflammatory or infectious response. In postpartum clients, a WBC this high, especially with fever and uterine tenderness, suggests postpartum infection requiring immediate intervention. Findings Not Requiring Immediate Follow-Up Heart rate 104/min: Mild tachycardia is expected postpartum, especially with mild fever, pain, or anemia. Not immediately concerning alone. Respiratory rate 18/min: Within normal limits for an adult (12–20/min). BP 108/70 mmHg: Normal postpartum blood pressure; does not indicate acute compromise. Hemoglobin 11.1 g/dL: Within acceptable postpartum range (>11 g/dL), not indicative of acute bleeding or anemia.