A nurse is caring for a client who is pregnant. The nurse is reviewing the client's medical record.

Exhibits

Select 4 findings that indicate a potential prenatal complication

Rationale for Correct Answers:

1. Condition: Mastitis
Mastitis is an infection of the breast tissue that commonly affects breastfeeding women. It often occurs when bacteria (usually Staphylococcus aureus) enter through a cracked or damaged nipple, allowing pathogens to travel into the milk ducts. Symptoms can start with nipple pain and breast tenderness, progressing to flu-like symptoms, localized redness, and fever if untreated.

2. Evidence: Cracked nipple
The client's report of nipple discomfort throughout feeding and visible crack noted on the left nipple are red flags for potential bacterial entry, placing her at high risk for mastitis. Cracked nipples are common in breastfeeding, especially when there is poor latch or prolonged feeding.

Rationale for Incorrect Options:

Endometritis: This is an infection of the uterine lining. However, this client is 2 weeks postpartum, denies abdominal pain, and has normal lochial progression (whitish-yellow discharge = lochia alba). Her uterus is no longer palpable, indicating appropriate involution. No signs of fever, foul-smelling discharge, or uterine tenderness are noted.

Perineal hematoma: This would present with significant perineal pain, swelling, and possibly bluish discoloration. This client reports only mild perineal discomfort (2/10), likely related to normal healing from her episiotomy.

Group B streptococcus: The client tested negative for Group B Streptococcus. Moreover, GBS is not directly related to cracked nipples or mastitis.

Large for gestational age newborn: While the newborn was indeed LGA, this mainly increases the risk for perineal trauma or shoulder dystocia, not directly mastitis.

Rationale:

A. "Preventing readmissions will decrease overutilization of services.": Preventing avoidable hospital readmissions reduces repeated use of costly healthcare resources, improves patient outcomes, and avoids financial penalties tied to excessive readmissions.

B. "Hiring travel nurses is an effective method of cost containment.": While travel nurses fill staffing gaps, they often come at a higher cost due to agency fees, housing, and incentives. Relying on them long-term is generally not considered cost-effective.

C. "Purchasing more expensive items will improve quality health outcomes.": Higher cost does not always translate to better outcomes. Cost-effectiveness involves achieving the best results at the lowest possible cost, not simply spending more on supplies or equipment.

D. "Planning a 10-year budget will ensure cost-effective care.": Long-term planning is helpful, but health care demands and costs change rapidly. Effective cost management requires regular review and adjustment, not just extended projections.