Jennifer Adamson, a 34-year-old single primipara, left the hospital after a 36-hour stay with her newborn son. She lives alone in a one-bedroom walk-up apartment. As the postpartum home health nurse visiting her 2 days later, you find the following:
• Tearful client pacing the floor holding her crying son
• Home cluttered and in disarray
• Fundus firm and displaced to right of midline
• Moderate lochia rubra; episiotomy site clean, dry, and intact
• Vital signs within normal range; pain rating less than 3 points on scale of 1 to 10
• Breasts engorged slightly; supportive bra on
• Newborn assessment within normal limits
• Distended bladder upon palpation; reporting urinary frequency
a. Which of these assessment findings warrants further investigation?
b. What interventions are appropriate at this time, and why?
c. What health teaching is needed before you leave this home?
