A nurse is caring for a client who is in active labor and is scheduled to receive epidural anesthesia.
Which of the following actions should the nurse take?

Choice A rationale

A hematoma presents as a localized collection of blood outside the blood vessels, causing a purplish discoloration and swelling, often resulting from trauma during delivery.

Choice B rationale

Retained placental fragments may cause postpartum hemorrhage and infection but would not present as a localized purplish swelling on the perineum.

Choice C rationale

A laceration would involve a tear in the tissue, causing bleeding and pain, but not necessarily a purplish discoloration with localized swelling unless associated with a hematoma.

Choice D rationale

Ecchymosis refers to bruising but is typically a more diffuse discoloration rather than a localized swelling and purplish area as seen with a hematoma.

Choice A rationale

Leukorrhea is a common and normal occurrence in pregnancy due to increased estrogen production and greater blood flow to the vaginal area. It is usually a thin, white discharge and not a cause for concern unless accompanied by itching, burning, or an unusual odor.

Choice B rationale

Excessive salivation, also known as ptyalism, can occur during pregnancy, particularly in the first trimester. It is linked to hormonal changes and is not typically harmful, though it may be uncomfortable for the patient.

Choice C rationale

Darkening of the skin on the face, known as melasma or chloasma, is common during pregnancy and is due to increased pigmentation from hormonal changes. It typically resolves postpartum and is not harmful.

Choice D rationale

Epigastric pain in a pregnant client at 33 weeks gestation can be a sign of preeclampsia, a serious condition characterized by high blood pressure and damage to other organs. It requires immediate medical attention to prevent complications for both the mother and baby.