A nurse is assessing self-management skills for a client who has preeclampsia without severe features. Which of the following client statements should the nurse recognize as an indication the client is coping effectively?

Rationale for Correct Choices

• Mastitis: The client is breastfeeding and presents with a visible cracked nipple, which provides an entry point for bacteria. Mastitis is a common postpartum infection of the breast tissue, particularly when nipple trauma or milk stasis is present, increasing the risk of inflammation and infection.

• Cracked nipple: The cracked nipple is a clear portal of entry for bacteria, especially Staphylococcus aureus. This physical finding directly predisposes the client to mastitis, making it the most immediate risk factor in this scenario.

Rationale for Incorrect Choices

• Perineal hematoma: A perineal hematoma typically occurs shortly after delivery due to trauma to the perineal blood vessels. This client is 2 weeks postpartum, with only mild perineal discomfort reported, making a hematoma unlikely at this stage.

• Endometritis: Endometritis usually presents within the first week postpartum with fever, uterine tenderness, and foul-smelling lochia. This client denies abdominal pain, has no fever, and reports normal lochia, making endometritis unlikely.

• Large for gestational age newborn: While the client delivered a newborn weighing 4,508 g, this factor primarily increases the risk for birth trauma, shoulder dystocia, or perineal injury. It does not directly predispose to mastitis.

• Group B streptococcus: Group B strep status primarily affects the newborn risk and prophylactic antibiotic decisions during labor. In the absence of postpartum infection symptoms in the mother, GBS is not the key factor contributing to mastitis in this client.

Rationale:
A. A client who is receiving a blood transfusion and reports low-back pain: Low-back pain during a blood transfusion indicates a possible acute hemolytic reaction caused by ABO incompatibility. This is a life-threatening emergency that requires immediate discontinuation of the transfusion and notifying the provider to prevent renal failure and shock.

B. A female client who is scheduled for chemotherapy and has an RBC count of 4.0 x10⁶/µL (4.2–5.4 x10⁶/µL): Although the RBC count is slightly low, this finding is not immediately life-threatening. The provider should be informed, but the client does not require urgent intervention.

C. A client who is 24 hr postoperative following a transurethral resection of the prostate and has small blood clots in the drainage tubing: Small clots are expected during the first 24 to 36 hours post-TURP due to residual bleeding from the surgical site.

D. A client who is 2 days postoperative following placement of an ascending colostomy and has shreds of bloody mucus in the bag: Small amounts of bloody mucus are normal during the early postoperative phase as the bowel mucosa heals.