Which of the following would the nurse included in her discharge education for a postpartum patient regarding…

Explanation

Core Concept: Normal postpartum lochia progresses through three stages: rubra (bright red, days 1-3), serosa (pinkish-brown, days 4-10), and alba (yellowish-white, days 11-21). Persistent lochia rubra beyond day 4 indicates delayed uterine involution, subinvolution, or retained placental fragments.

Clinical Presentation:

• Bright red, heavy vaginal bleeding persisting beyond the first few days postpartum.
• Potential for foul-smelling lochia, pelvic pain, or fever if infection is present.

Diagnosis:

• First-line diagnostic plan: Physical examination of the uterus (checking for boggy or enlarged fundus) and assessment of lochia.
• Most accurate (gold standard) test: Pelvic ultrasound to visualize the uterine cavity for retained products of conception (RPOC).

Management:

• Acute management: Administer prescribed uterotonic agents (e.g., methylergonovine, misoprostol) to stimulate uterine contraction and control bleeding.
• Gold standard long-term management: If retained tissue is confirmed or bleeding is severe, a dilation and curettage (D&C) may be required. Broad-spectrum antibiotics are added if endometritis is suspected.