Questions: A nurse is assessing a client who is 3 days postpartum and is breastfeeding. The nurse notes that the fundus is three fingerbreadths below the umbilicus, lochia rubra is moderate, and the breasts are hard and warm to palpation. Which of the following interpretations of these findings should the nurse make? - The client is exhibiting early indications of mastitis. Additional interventions are not indicated at this time. Application of a heating pad to the breasts is indicated. The client should be advised to remove her nursing bra.

A nurse is assessing a client who is 3 days postpartum and is breastfeeding. The nurse notes that the fundus is three fingerbreadths below the umbilicus, lochia rubra is moderate, and the breasts are hard and warm to palpation. Which of the following interpretations of these findings should the nurse make?
- The client is exhibiting early indications of mastitis.
Additional interventions are not indicated at this time.
Application of a heating pad to the breasts is indicated.
The client should be advised to remove her nursing bra.
Transcript text: A nurse is assessing a client who is 3 days postpartum and is breastfeeding. The nurse notes that the fundus is three fingerbreadths below the umbilicus, lochia rubra is moderate, and the breasts are hard and warm to palpation. Which of the following interpretations of these findings should the nurse make? - The client is exhibiting early indications of mastitis. Additional interventions are not indicated at this time. Application of a heating pad to the breasts is indicated. The client should be advised to remove her nursing bra.
failed

Solution

failed
failed

The answer is the first one: The client is exhibiting early indications of mastitis.

Explanation for each option:

  1. The client is exhibiting early indications of mastitis.

    • Correct: The symptoms described—hard and warm breasts—are indicative of early mastitis, which is an infection of the breast tissue that results in breast pain, swelling, warmth, and redness. It is common in breastfeeding women and requires prompt attention to prevent complications.
  2. Additional interventions are not indicated at this time.

    • Incorrect: Given the symptoms of hard and warm breasts, it is important to address the potential for mastitis. Ignoring these symptoms could lead to worsening of the condition.
  3. Application of a heating pad to the breasts is indicated.

    • Incorrect: While warmth can sometimes help with milk flow, in the case of suspected mastitis, applying heat could potentially exacerbate the infection. Cold compresses are often recommended to reduce swelling and pain.
  4. The client should be advised to remove her nursing bra.

    • Incorrect: Removing the nursing bra is not a standard recommendation for managing symptoms of mastitis. Properly fitting bras are important for support, and other interventions such as antibiotics or continued breastfeeding/pumping are more appropriate.

Summary: The nurse should interpret the findings as early indications of mastitis and take appropriate actions to address the condition, such as advising the client to continue breastfeeding or pumping to relieve engorgement and possibly consulting a healthcare provider for further management.

Was this solution helpful?
failed
Unhelpful
failed
Helpful