Safe, Effective Care Environment
48. A client, who is a 19-year-old gravida 2, para 1, delivers a 10-pound neonate by cesarean section after 36 hours of labor and failure to progress. The client has developed abdominal tenderness, a fever of 102.2°F (39°C), and foul-smelling lochia. A nurse should recognize that the most likely reason for the client's condition is:
Test-Taking Tip
Endometriosis and endometritis sound similar; the ending "itis" usually indicates infection.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Safe and Effective Care Environment/Safety and Infection Control/Standard/Transmission-based/Other Precautions
Safe, Effective Care Environment
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Answer 1 is incorrect because endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body. It is not an infection and does not cause fever, abdominal tenderness, or foul-smelling lochia. Answer 2 is incorrect because, even though this client is at risk for postoperative wound infection, a postoperative wound infection does not cause foul-smelling lochia. Answer 3 is incorrect because, although this client is at risk for pelvic thrombophlebitis, which causes fever, it does not have foul-smelling lochia or abdominal tenderness. Answer 4 is correct because the most common reason for postpartum fever is endometritis. Other symptoms include abdominal tenderness and foul-smelling lochia. Postpartum endometritis occurs in 15% to 20% of unscheduled cesarean deliveries after a prolonged labor.
