Question

Upon admission to the postpartum room, 3 hours after delivery, a client has a temperature of 99.5 degrees F. What nursing actions are indicated?

a) Assess vital signs every 30 minutes
b) Inform the physician immediately
c) Continue to monitor and reassess
d) Administer antipyretics

Answer 1

A temperature of
`99.5` degrees F postpartum is not usually cause for immediate concern. The nurse should continue to monitor and reassess the client's temperature along with other vital signs to ensure no development of complications.

Step-by-step explanation:

Upon admission to the postpartum room,
`3` hours after delivery, a client with a temperature of
`99.5` degrees F typically does not require immediate aggressive action, as this can be a normal finding. However, it is important for nursing staff to monitor the situation to ensure the temperature does not indicate an infection or other complications. The best action is c) Continue to monitor and reassess. The temperature should be reassessed regularly along with other vital signs to detect any signs of postpartum complications like puerperal fever.

The nurse should remain vigilant for any other signs of infection or distress and report any significant changes to the physician. Administering antipyretics would not be indicated unless there is a more significant fever or as per the physician's orders.