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 umbillous 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 choices • Temperature 38.2° C (100.8° F). An elevated temperature in a postpartum client may indicate infection, especially in the context of prolonged rupture of membranes and cesarean delivery. Prompt follow-up is required to identify the source and initiate treatment to prevent progression to sepsis. • WBC count 33,000/mm³. A markedly elevated WBC suggests an active inflammatory or infectious process. In postpartum clients, leukocytosis can signal endometritis, mastitis, or surgical site infection, necessitating immediate assessment and intervention. • Client reports feeling unwell. A general feeling of being ill or "not right" in a postpartum client with fever is a significant subjective finding often preceding more objective signs of infection/sepsis. • Uterus firm at 1 cm above the umbillous and tender to palpation. Uterine tenderness combined with fever and foul-smelling lochia is a cardinal sign of endometritis (infection of the uterine lining), the most common postpartum infection, especially after Cesarean section. • Moderate amount of dark brown, foul-smelling lochia. Foul-smelling lochia is a hallmark of uterine infection such as endometritis. Combined with fever and leukocytosis, this finding warrants urgent evaluation, monitoring, and possible initiation of antibiotics. • Breasts firm, heavy, and warm with nipple discomfort. These signs are consistent with mastitis, particularly in a breastfeeding client. Early recognition and treatment with supportive measures or antibiotics prevent worsening infection and systemic involvement. • Fundus boggy but firmed with massage. A boggy fundus indicates uterine atony, which can lead to postpartum hemorrhage. Immediate attention is required to prevent excessive blood loss and maintain hemodynamic stability. Rationale for incorrect choices • Vital signs: Heart rate while slightly elevated can be physiologic due to postpartum recovery, mild fever, or pain. Respiratory rate is within normal limits for adults; does not indicate acute compromise. Blood pressure is within normal postpartum range and does not signal hemodynamic instability at this time. Oxygen saturation is normal, indicating adequate oxygenation. • Surgical incision well approximated with slight edema, no redness or drainage: Mild edema at the incision site is expected and not indicative of infection at this time. Regular monitoring is appropriate. • No bowel movement since birth, hypoactive bowel sounds: Delayed bowel movements and hypoactive sounds are common postpartum, especially after cesarean section. Monitoring and supportive care are sufficient unless other symptoms develop.