A nurse is caring for a 28-year-old female client who is 2 days postpartum in the postpartum unit following a cesarean birth. For each finding below, click to specify if the finding is consistent with the disease process of lactational mastitis, postpartum endometritis, or postpartum hemorrhage. Each finding may support more than one disease process.

Exhibits

For each finding below, click to specify if the finding is consistent with the disease process of lactational mastitis, postpartum endometritis, or postpartum hemorrhage. Each finding may support more than one disease process.

Choice A rationale

A displaced fundus from the midline, often deviated to the right and boggy, suggests a full bladder interfering with uterine contraction and involution. A distended bladder prevents the uterus from clamping down effectively, increasing the risk of postpartum hemorrhage. Immediate intervention is required to assist the client in emptying her bladder, which should allow the uterus to return to the midline and contract firmly.

Choice B rationale

A fundal height below the umbilicus on the first postpartum day is a normal finding. Following delivery, the uterus begins to descend approximately one fingerbreadth (1 cm) per day. Therefore, a fundus below the umbilicus at 24 hours postpartum indicates normal uterine involution.

Choice C rationale

A decreased urge to void is common in the immediate postpartum period due to factors such as perineal swelling, pain, and the effects of anesthesia. While it's important to monitor urinary output, a decreased urge to void in the first 24 hours is not typically considered a finding requiring immediate intervention unless accompanied by other signs of urinary retention or bladder distension.

Choice D rationale

Increased urine output is also a normal finding in the postpartum period as the body eliminates excess fluid volume accumulated during pregnancy. Diuresis typically begins within 12 to 24 hours after delivery and can last for several days. This is a physiological process and does not require immediate intervention.

The condition that poses the greatest risk to the newborn is meconium aspiration syndrome due to amniotic fluid.

Rationale for correct answers

Meconium aspiration syndrome (MAS) occurs when a newborn inhales meconium-stained amniotic fluid, leading to airway obstruction, chemical pneumonitis, and surfactant dysfunction. The presence of dark brown-greenish amniotic fluid, along with mild respiratory distress (nasal flaring, increased respiratory rate of 60/min), raises concern for MAS. Close monitoring for worsening respiratory symptoms is essential.

Amniotic fluid contamination with meconium increases the risk of lung inflammation and infection. The newborn’s vigorous condition suggests mild aspiration, but continuous observation is needed.

Rationale for incorrect Response 1 options

• Jaundice: While term newborns may develop physiological jaundice, there are no indications of hyperbilirubinemia or hemolysis in this case.
• Hypoglycemia: No jitteriness or poor feeding, and birth weight is within normal range; hypoglycemia more commonly affects preterm or low birth weight infants.
• Cold stress: The newborn is under a radiant warmer, and temperature is within normal range (36.5°C).

Rationale for incorrect Response 2 options

• Birth weight: No signs of growth restriction or macrosomia-associated complications.
• Acrocyanosis: Normal in newborns due to immature circulation, not an indicator of respiratory compromise.
• Apgar scores: Strong Apgar scores (8 and 9) suggest good adaptation to extrauterine life.