A. 1+ edema on her lower extremities: Mild edema in the lower extremities is a common finding in the third trimester due to increased blood volume and venous stasis. It is not necessarily a concerning finding unless accompanied by signs of preeclampsia, such as hypertension or proteinuria.
B. Fundal height of 30 cm: At 34 weeks of gestation, the fundal height is typically expected to be within 2 cm of the gestational age (32–36 cm). A measurement of 30 cm is below the expected range and may indicate intrauterine growth restriction (IUGR) or oligohydramnios. This finding requires further evaluation by the healthcare provider.
C. Weight gain of 2 pounds (0.91 kg): A weight gain of approximately 1–2 pounds (0.45–0.91 kg) per week in the third trimester is within the normal range for pregnancy and does not require immediate intervention.
D. Fetal heart rate of 110 beats/minute: The normal fetal heart rate ranges between 110–160 beats per minute. While 110 bpm is at the lower end of normal, it is still within an acceptable range and does not necessarily indicate fetal distress. However, continued monitoring may be warranted if there are additional concerns.

A. Rupture of membranes for 16 hours – The risk of postpartum infection, particularly endometritis, increases with prolonged rupture of membranes because bacteria can ascend into the uterus after the amniotic sac is broken. Although infection risk is higher after 18 hours, 16 hours still poses a concern, especially when combined with other signs of infection.
B. Normal spontaneous vaginal birth – A vaginal delivery is a routine event that does not inherently increase the risk of infection unless complicated by prolonged labor, excessive blood loss, or retained placental fragments. While it is relevant to the patient’s history, it does not directly contribute to the current symptoms.
C. Breastfeeding 7 to 8 times a day for 10 minutes – While frequent nursing can sometimes contribute to sore nipples, it does not directly indicate an infection unless there are additional signs of inadequate emptying or poor latch.
D. Discharge hemoglobin of 9.2 g/dL (92 g/L) – A postpartum hemoglobin level lower than 11 g/dL suggests anemia, which can lead to fatigue, dizziness, and a weakened immune response. While anemia does not directly cause infection, it can contribute to the client’s symptoms of fatigue and dizziness and make it harder for the body to fight infections.
E. Current vital signs – The presence of fever (101.2°F/38.4°C) and tachycardia (105 beats/min) indicates a systemic inflammatory response, strongly suggesting an active infection. Given the combination of fever, chills, and breast tenderness, mastitis is a likely concern. Additionally, the foul-smelling lochia raises suspicion for endometritis.
F. Shopping yesterday for 5 hours – Being away from the baby for an extended period may have led to milk stasis, increasing the risk of mastitis. When milk is not regularly emptied, bacterial overgrowth can occur, leading to inflammation and infection, which aligns with the red, warm, firm area on the breast.
G. Foul-smelling lochia rubra – Lochia rubra persisting at two weeks postpartum, particularly with a foul odor, is a classic sign of endometritis, a postpartum uterine infection. Normal postpartum bleeding transitions from rubra to serosa, and foul-smelling discharge indicates bacterial overgrowth in the uterus, requiring prompt antibiotic treatment.

• Pulse of 105 beats/minute – Both mastitis and endometritis
  Tachycardia (heart rate >100 bpm) is a systemic response to infection and inflammation, which can occur in both mastitis and endometritis. In mastitis, infection in the breast tissue triggers a systemic inflammatory response, while in endometritis, uterine infection can cause sepsis-related tachycardia.
• Feeling chilled, achy, and fatigued – Both mastitis and endometritis
  Both conditions can cause systemic flu-like symptoms, including chills, body aches, and fatigue, as the body mounts an immune response. Mastitis leads to generalized malaise due to localized infection and inflammation in the breast, while endometritis causes uterine infection, which can spread if untreated.
• Baby fed pumped breast milk – Mastitis
  Mastitis often develops due to milk stasis when the breasts are not fully emptied. The client was away from the baby for several hours while feeding pumped milk, which may have led to incomplete drainage of the breast, increasing the risk of bacterial overgrowth and mastitis.
• Pain rating of 4 on a 0 to 10 scale – Mastitis
  Pain in mastitis is usually localized to the affected breast, presenting as a red, firm, warm area. The uterine pain in endometritis is generally more cramp-like and associated with uterine tenderness, rather than a focal area of pain like in mastitis.
• Foul-smelling lochia rubra at 2 weeks postpartum – Endometritis
  Lochia should transition from rubra (red) to serosa (pink-brown) to alba (white/yellow) within 2 weeks postpartum. Foul-smelling, persistent lochia rubra is a hallmark sign of endometritis, indicating bacterial overgrowth in the uterus.
• Temperature of 101.2° F (38.4°C) – Both mastitis and endometritis
  Fever is a key symptom of both mastitis and endometritis as the body responds to infection. Mastitis causes localized breast infection with systemic symptoms, while endometritis results in uterine infection and systemic inflammatory response.

A. Wear an underwire bra around the clock. Tight-fitting bras, especially underwire bras, can contribute to milk stasis by restricting milk flow and increasing the risk of clogged ducts. Instead, the client should wear a well-fitted, supportive bra without underwire to promote comfort and adequate milk drainage.
B. Apply warm compresses to affected area before feeding. Warm compresses help increase circulation, promote milk let-down, and relieve pain in cases of mastitis. Applying warmth before breastfeeding can help soften the breast and improve milk flow, reducing milk stasis.
C. Pump breasts if feeding will be missed, due to absence from the infant. Milk stasis occurs when the breast is not emptied regularly, increasing the risk of mastitis. Pumping or hand-expressing milk when unable to breastfeed prevents engorgement and reduces the likelihood of infection.
D. Pump breastmilk and feed it to infant instead of nursing. Direct breastfeeding is preferred unless the pain is too severe or an abscess has formed. Pumping can be beneficial to relieve engorgement, but exclusive pumping is not necessary in mastitis unless advised by a healthcare provider. Continued direct breastfeeding helps clear infection by draining the affected breast.
E. Finish antibiotics even if symptoms improve. Mastitis is commonly treated with antibiotics, and completing the full course prevents recurrence and antibiotic resistance. Stopping antibiotics early can lead to incomplete eradication of bacteria and persistent infection.
F. Maintain activity due to the risk of blood clots with extra rest. Rest is essential for recovery from infection, and while postpartum clients have a slightly higher risk for blood clots, moderate rest should be encouraged. The client should engage in light activity as tolerated but should not avoid rest, as fatigue can contribute to a weakened immune response.
G. Wash hands before handling the breast. Mastitis can be caused by bacterial contamination from the skin, baby’s mouth, or hands. Proper hand hygiene before breastfeeding or pumping reduces the risk of introducing bacteria into milk ducts and worsening the infection.
H. Start infant on the unaffected side, so there is less pain when infant is the hungriest. Babies suck more vigorously at the beginning of a feeding. Starting on the unaffected side reduces pain and discomfort in the affected breast while ensuring the infant is still able to empty both breasts adequately.
I. Vary breastfeeding positions at each feeding. Different nursing positions help ensure all milk ducts are effectively drained, reducing the risk of continued milk stasis. Positions such as cradle hold, football hold, or side-lying nursing can improve drainage in different areas of the breast.

• Plugged duct: A plugged duct occurs when milk is not effectively drained from the breast, leading to milk stasis and inflammation. If untreated, it can progress to mastitis, an infection caused by bacterial overgrowth in stagnant milk. The client's history of missing a feeding while shopping increases the likelihood of milk stasis, making a plugged duct the most likely cause of mastitis.
• Breast abscess: A breast abscess is a collection of pus that forms when mastitis is left untreated or does not respond to antibiotics. Unlike mastitis, an abscess is typically fluctuant (soft and fluid-filled), extremely tender, and may require drainage. Since the client’s mastitis symptoms have just begun, an abscess is unlikely at this stage.
• Engorgement : Breast engorgement occurs when the breasts overfill with milk, causing swelling and discomfort. While engorgement can increase the risk of mastitis, it is not an infection itself and does not directly cause mastitis unless milk stasis leads to bacterial overgrowth. Engorgement is bilateral, whereas mastitis is usually unilateral with localized redness, warmth, and fever.
• Nipple trauma with cracked skin: Cracked nipples can allow bacteria to enter the breast, increasing the risk of infection. However, mastitis is primarily caused by milk stasis, not just nipple trauma. In this client, there is no mention of nipple cracks or bleeding, making this a less likely cause.
• Firm, red, warm area on the right breast: A firm, red, warm, and tender area on the breast is a hallmark symptom of mastitis, indicating localized inflammation and infection. The presence of systemic symptoms (fever, chills, fatigue) further supports mastitis rather than another breast condition.
• Pus draining from the nipple: Pus or fluctuance (fluid-filled swelling) suggests a breast abscess, not mastitis. While untreated mastitis can lead to an abscess, this client’s symptoms do not indicate a severe or advanced infection requiring drainage.
• Generalized swelling of the entire breast: Severe engorgement can cause generalized swelling, but mastitis typically presents as a localized, inflamed area rather than affecting the entire breast. Engorgement also does not cause fever or systemic illness, which are present in mastitis.
• Pain that worsens with cold compresses: Cold compresses reduce inflammation and discomfort in mastitis. If cold worsens pain, it may suggest Raynaud’s phenomenon of the nipple, which is not related to mastitis. Mastitis pain is relieved with warmth, massage, and frequent breastfeeding.

• Mastitis: Mastitis is an infection of breast tissue that occurs when milk stasis leads to bacterial overgrowth, usually caused by Staphylococcus aureus. The client's firm, red, warm area on the breast, fever (101.2°F), chills, body aches, and fatigue all strongly indicate mastitis rather than other breast conditions.
• Engorgement: Engorgement occurs when the breasts overfill with milk, leading to swelling and tenderness. However, engorgement typically affects both breasts, does not cause fever or flu-like symptoms, and resolves with regular breastfeeding or pumping.
• Blocked milk duct: A clogged duct occurs when milk flow is obstructed, leading to a tender lump in the breast. While a blocked duct can progress to mastitis, it does not cause fever or systemic symptoms unless infection develops. The presence of fever and flu-like symptoms in this client suggests mastitis, not just a blocked duct.
• Inflammatory breast cancer: This rare but aggressive form of breast cancer causes redness, swelling, and skin thickening, but it is not associated with fever or acute symptoms like mastitis. It does not develop suddenly but rather progresses over time, making mastitis the more likely diagnosis in this case.
• Abscess: If mastitis is not treated promptly, it can lead to a breast abscess, a localized collection of pus requiring drainage. Signs of progression to an abscess include fluctuant swelling, worsening pain, and persistent fever despite antibiotic treatment.
• Breastfeeding intolerance: Mastitis can cause temporary discomfort during breastfeeding, but it does not lead to true breastfeeding intolerance. In fact, continued breastfeeding helps resolve mastitis by improving milk drainage.
• Nipple thrush: Nipple thrush (Candida infection) causes burning pain and white patches in the infant’s mouth but is not a complication of mastitis, which is bacterial, not fungal.
• Postpartum haemorrhage: Postpartum hemorrhage is caused by uterine atony, retained placenta, or coagulation disorders, not mastitis. Mastitis is localized to the breast and does not affect uterine bleeding.

A. After a feeding, the nipple is creased. A creased nipple suggests a poor latch, which can lead to ineffective milk removal and increase the risk of recurrent mastitis. A proper latch should be deep, with the baby covering a large portion of the areola, ensuring effective drainage of the breast.
B. The feelings of fatigue continue, but there are no chills, achiness, or dizziness. While the absence of chills, achiness, and dizziness indicates improvement, persistent fatigue may suggest anemia, inadequate hydration, or continued recovery from infection. Fatigue alone does not confirm complete resolution of mastitis.
C. The infant continues to want to nurse all the time. Cluster feeding can be normal during growth spurts, but persistent frequent feeding beyond 2–3 hours may indicate poor milk transfer, low supply, or ineffective latch. Mastitis resolution should result in more effective milk drainage and a more predictable feeding pattern.
D. The temperature taken at home is 99.0° F (37.2° C). A normal temperature suggests that the infection and systemic inflammation have resolved. Mastitis is characterized by fever, so its absence indicates improvement.
E. Pain during feeding lasts for 10 of the 20 minutes of the feed. Persistent pain, especially for half the feeding duration, may indicate ongoing inflammation, nipple trauma, or unresolved infection. Resolution of mastitis should lead to pain-free or minimal discomfort during feeding.
F. Pumping continues on the right side instead of breastfeeding on that side. If the affected breast is still too painful for direct nursing, this suggests ongoing inflammation or poor resolution of mastitis. Ideally, the mother should be able to comfortably breastfeed from both breasts.
G. The red area on her right breast has resolved. The disappearance of redness, swelling, and warmth indicates resolution of localized inflammation and infection, confirming improvement in mastitis.
H. The infant is breastfeeding every 2 to 3 hours for 20 minutes in a variety of positions. Effective breastfeeding frequency and positioning ensure proper milk drainage, reducing the risk of recurrence. Mastitis resolution should allow the mother to comfortably breastfeed at regular intervals with different holds to promote complete emptying of all milk ducts.

A. Giving pain medication around the clock helps control the pain. Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that can cause persistent joint pain and stiffness. Administering pain medication on a scheduled basis, rather than waiting for severe pain, helps maintain consistent pain control, reduces inflammation, and improves mobility. This approach prevents pain from becoming severe, which can be harder to manage and may lead to joint damage or decreased function.
B. The use of hot baths can be used as an alternative for pain medication. Warm baths can help relieve joint stiffness and improve comfort, but they do not replace the need for scheduled pain management. While non-pharmacologic interventions are helpful, they should be used in combination with appropriate medication to ensure adequate pain relief and prevent long-term complications.
C. The child should be encouraged to rest when experiencing pain. While adequate rest is important, excessive inactivity can worsen stiffness and joint contractures in children with JIA. A balance between rest and activity, including gentle exercises and physical therapy, is crucial to maintaining joint mobility and preventing functional impairment.
D. Encourage quiet activities such as watching television as a pain distracter. Distraction techniques can help with coping, but they do not address the underlying inflammatory pain associated with JIA. Effective pain management requires both pharmacologic and non-pharmacologic strategies to ensure the child's comfort and ability to participate in daily activities.

A. Avoid any smoking inside the house. Exposure to secondhand smoke increases the risk of recurrent otitis media by irritating the respiratory tract and impairing mucociliary clearance. Reducing or eliminating smoke exposure is an essential preventive measure to lower inflammation and decrease bacterial colonization in the middle ear.
B. Give infant the full course of antibiotics. Completing the full course of prescribed antibiotics ensures that the infection is fully treated, preventing bacterial resistance and reducing the likelihood of recurrent or persistent infections. Stopping antibiotics prematurely can lead to incomplete eradication of the bacteria and increase the risk of future infections.
C. Schedule visit for pneumococcal vaccine. The pneumococcal vaccine protects against Streptococcus pneumoniae, one of the leading causes of otitis media. Ensuring that the infant is up to date with routine vaccinations, including the pneumococcal and Haemophilus influenzae type B (Hib) vaccines, can significantly reduce the risk of recurrent infections.
D. Instill benzocaine otic drops regularly. Benzocaine otic drops provide temporary pain relief but do not prevent or treat infections. Using them regularly without medical guidance may mask symptoms of worsening infection, delay appropriate treatment, or cause local irritation. Pain management should be used only as needed and in conjunction with appropriate medical interventions.

Calculate the total daily dose:

Total daily dose (mg) = Weight (kg) x Dosage (mg/kg/day)

= 25 kg x 10 mg/kg/day

= 250 mg/day

Calculate the volume to administer per dose:

Volume to administer (mL) = Desired dose (mg) / Available concentration (mg/mL)

Available concentration = 50 mg / 5 mL

= 10 mg/mL

Volume to administer (mL) = 250 mg / 10 mg/mL

= 25 mL

The nurse should administer 25 mL per dose.