The nurse is continuing to care for the client. 

Exhibits

The nurse is reviewing the assessment findings.

For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.

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. Place a warm pack on the incisional area: Applying a warm pack immediately postoperatively can increase blood flow and risk bleeding or swelling at the surgical site. Cold packs are generally preferred in the immediate postoperative period to reduce inflammation.

B. Restrict fluids to 1,200 mL per day: Fluid restriction is not indicated after hernia repair unless the client has a comorbid condition like heart or renal failure. Adequate hydration supports healing and normal bowel and urinary function.

C. Elevate the client's scrotum on a pillow: Elevating the scrotum helps reduce swelling and discomfort after hernia repair, especially if the inguinal area is involved. This intervention promotes venous return and prevents complications like hematoma formation.

D. Encourage the client to sit to void: Sitting to void is not routinely necessary after hernia repair unless the client has mobility issues. There’s no specific benefit to this position in a typical male postoperative client.