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/mm)

Client reports feeling unwell: This is clinically significant when combined with fever, foul-smelling lochia, and elevated WBCs; it could indicate systemic infection such as endometritis. Fundus boggy but firms with massage: Indicates uterine atony, a risk factor for postpartum hemorrhage. Even if it responds to massage, repeated bogginess suggests the need for uterotonic medications and close monitoring. Foul-smelling, dark brown lochia: These findings are highly suggestive of uterine infection (endometritis), especially when paired with uterine tenderness, fever, and elevated WBCs. WBC count 33,000/mm³: Severely elevated — well above normal postpartum leukocytosis (typically up to 20,000/mm³). A level of 33,000 strongly suggests an ongoing infectious process. Temperature 38.2°C (100.8°F): Slightly elevated, and while low-grade fever is common postpartum, when associated with uterine tenderness and abnormal lochia, it raises concern for infection and should be monitored and managed appropriately. Lung sounds diminished in the bases: Could be due to post-surgical hypoventilation, immobility, or atelectasis. Should prompt encouragement of deep breathing, incentive spirometry, and ambulation. No bowel movement since birth, hypoactive bowel sounds: This is a common post-cesarean finding due to anesthesia and immobility, but it still indicates delayed return of GI function and should be monitored for signs of ileus.