The nurse provides a follow-up phone call to a client who gave birth at a birthing center 5 days ago. Which statement by the client should the nurse be most concerned about?

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11ecbb05_cc28_a983_b433_09eda4ecacd9_MD0009_00 Postpartum hemorrhage (PPH) may be primary (ie, <24 hours since birth) or secondary/delayed (ie, >24 hours but <6 weeks postpartum). Secondary PPH usually results from uterine subinvolution, retained placental fragments/membranes, or uterine infection. The nurse should expect a client >3-4 days postpartum to report a progressive change in lochia from lochia rubra (dark-red vaginal bleeding) to lochia serosa (pink or brown discharge). A gradual decrease in the amount of lochia is reassuring and expected. However, reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots (ie, larger than a nickel) are concerning findings that require the nurse's immediate follow-up (Option C). (Option A) Postpartum fatigue is common due to the adjustments needed to provide newborn care or may be related to postpartum anemia. Follow-up is necessary, but it is not the most concerning statement. (Option B) Bright red bleeding with defecation is associated with hemorrhoids, a common finding in pregnancy. Hemorrhoids usually begin to shrink following birth. (Option D) Physiologic fluid retention in pregnancy may cause medial nerve compression (ie, carpal tunnel syndrome), an expected discomfort of pregnancy marked by a tingling or burning sensation of the hands. Educational objective: Secondary or delayed postpartum hemorrhage (PPH) occurs >24 hours but <6 weeks postpartum. Reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots are concerning findings associated with secondary PPH.

The Nurse Provides a Follow-Up Phone Call to a Client