A nurse is teaching a client who is at 14 weeks of gestation about expected body changes during pregnancy.
Which of the following manifestations should the nurse include in the teaching?

🧾 Explanation

1. Moderate lochia rubra
   • Normal up to 1–2 weeks postpartum. Not related to mastitis.
2. Temperature 38.4°C
   • Still febrile after 24 hrs of antibiotics → infection not yet controlled.
3. Purulent nipple discharge
   • New finding. Indicates possible breast abscess or worsening mastitis.
4. Hemoglobin 12 g/dL
   • Stable and within normal range. Not relevant to mastitis progression.
5. WBC 35,000/mm³
   • Increased from 28,000 → worsening systemic inflammatory response.
6. Decreased pain
   • Symptomatically better, but this may reflect partial relief from antibiotics/analgesics rather than full resolution. Still, it’s a positive sign.

Summary:

• Improving: Pain relief.
• Unrelated: Lochia rubra, hemoglobin.
• Worsening: Persistent fever, purulent nipple discharge, rising WBC.

This mixed picture suggests partial response but possible complication (breast abscess). The nurse should notify the provider promptly, anticipate breast ultrasound to rule out abscess, and continue close monitoring.

Choice A rationale

Bilirubin monitoring is critical for jaundice due to hemolysis, often seen in ABO incompatibility or cephalohematoma. While Large for Gestational Age (LGA) infants can have polycythemia, hypoglycemia is a more immediate and life-threatening risk that requires priority monitoring in the first hours of life. The normal total bilirubin range is typically less than 5 mg/dL in the first 24 hours.

Choice B rationale

LGA infants are often born to mothers with uncontrolled or gestational diabetes, leading to fetal hyperinsulinism. After birth, the maternal glucose supply is cut off, and the high insulin levels persist, causing a rapid and profound drop in the newborn's blood glucose, hence hypoglycemia is a major concern. The normal newborn glucose range is 40 to 60 mg/dL and should be monitored.

Choice C rationale

White blood cell (WBC) count is primarily monitored to detect neonatal sepsis or infection. While all newborns are at risk, the LGA classification does not inherently place them at a higher, unique risk for infection compared to the immediate metabolic derangement risks like hypoglycemia. The normal WBC count range is 9,000 to 30,000 cells/mm.

Choice D rationale

Arterial Blood Gases (ABGs) are used to assess the newborn's respiratory status and acid-base balance, particularly in respiratory distress syndrome or persistent pulmonary hypertension. While LGA infants can experience birth trauma or meconium aspiration, ABG monitoring is not routine unless significant respiratory symptoms are present.