A breastfeeding woman develops engorged breasts at 3 days postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman:

A) Apply an ice pack to the perineum:
For a second-degree perineal laceration sustained during delivery, ice application is an important intervention within the first 24 hours to reduce swelling, pain, and inflammation in the perineal area. Ice packs help constrict blood vessels, decrease tissue edema, and provide analgesic effects. This intervention is most effective immediately after delivery and within the first 2-4 hours to help manage pain and swelling at the site of the laceration.

B) Teach the woman to insert nothing into her rectum:
While it is true that women with perineal lacerations should avoid rectal trauma or anything inserted into the rectum (e.g., rectal thermometers, suppositories) for a period of time, this is not the most urgent or immediate action for this patient. The primary concern at this point is managing the acute symptoms related to the laceration (e.g., swelling, pain), which is best managed with ice packs and other measures. Teaching about avoiding rectal insertion would be important later in the postpartum period.
C) Advise the woman to sit on a pillow:
While sitting on a pillow can reduce pressure on the perineum and help with comfort, it is not the most immediate intervention for this woman, especially in the first few hours postpartum. The priority should be addressing swelling and pain associated with the perineal laceration, which is best managed with ice, as it helps with the acute management of the injury.

D) Advise the woman to use sitz bath after each void:
A sitz bath can be helpful for perineal healing in the postpartum period, but it is typically recommended after the first 24 hours post-delivery, after the initial swelling has gone down. During the first few hours to days postpartum, ice packs are generally the preferred intervention to manage swelling and pain, while sitz baths are often advised later to promote comfort, healing, and circulation in the perineum.

A) Soft, nontender, colostrum is present:
In the early postpartum period, specifically on day 1, the woman is still in the process of transitioning from producing colostrum (a thick, yellowish fluid rich in antibodies) to mature breast milk. The colostrum may be present, but the breasts are typically not soft and nontender. Instead, they are more likely to be swollen and tender as the milk production ramps up. Therefore, this is not the typical finding on day 1 postpartum.
B) Swollen, warm, and tender upon palpation:
This is the expected finding on day 1 postpartum, especially for a primiparous woman. After childbirth, the breasts begin the transition from producing colostrum to mature breast milk. The increased blood flow and milk production cause the breasts to become swollen, warm, and tender to the touch. This condition is often referred to as engorgement, which is common within the first few days after delivery, particularly in breastfeeding mothers. Engorgement usually peaks around day 3 but may begin to occur slightly earlier, as the body adjusts to milk production.

C) Leakage of milk at let-down:
This finding is more typical of a woman who is further along in the postpartum period, usually after her milk has transitioned from colostrum to mature milk. Milk let-down and the associated leakage typically occur later, often after a few days (around day 3 or later). On day 1, the milk supply is still establishing itself, and leakage is less common.

D) A few blisters and bruises on each areola:
Blisters and bruises on the areola could indicate improper latch or trauma from breastfeeding. This is not a typical or expected finding in a woman who is only 1 day postpartum. If this occurs, the nurse should assess the infant’s latch and the breastfeeding technique to prevent further complications. Such findings should be addressed promptly, but they are not considered normal on day 1.