A client is ordered 325mL of packed red blood cells over 3 hours. What is the rate to be set on the infusion pump? Round to a whole number

Client Finding Assessment:

White blood cell count (18,000/mm³)

Expected: An elevated white blood cell count is common postpartum due to the body's inflammatory response to delivery, especially within the first few days after birth. This level is within the typical postpartum range of 5,000 to 30,000/mm³.

Blood clot size (pea-sized)

Expected: Small blood clots are common during the early postpartum period. It is normal to see some small clots in the lochia as the uterus contracts and expels blood from the uterine lining.

Uterine findings (firm and midline, 1–2 cm below the umbilicus)

Expected: A firm, midline uterus with a descent of about 1–2 cm below the umbilicus is a normal finding during the early postpartum period. This indicates appropriate uterine involution.

Lochia findings (moderate to light amount, no odor, with clots)

Expected: Lochia rubra (red blood flow) is expected during the first few days postpartum, with moderate bleeding and the presence of small clots. The absence of foul odor suggests no infection, which is a positive sign.

Calf findings (one varicose vein visible on left calf)

Expected: It is common for women to have visible varicose veins during pregnancy due to increased blood volume and pressure on the veins. These may persist postpartum, and unless associated with pain or swelling, they do not typically require intervention.

Blood pressure (145/98 mm Hg)

Unexpected: Elevated blood pressure postpartum is concerning and could indicate postpartum hypertension or preeclampsia. This needs to be addressed and monitored closely as it can be a sign of a serious condition that requires further evaluation.

A) Goodell’s sign:
Goodell's sign refers to the softening of the cervix that occurs early in pregnancy, typically around 4–6 weeks. It is a probable sign of pregnancy due to increased vascularity and hormonal changes. However, it does not describe the movement of the fetus or the sensation felt by the provider when pressure is applied to the cervix.

B) Lightening:
Lightening refers to the sensation of the fetus dropping or descending into the pelvic cavity, which typically happens in the later stages of pregnancy (around 36 weeks or later). It is not related to the fetal movement felt by the provider through upward pressure on the cervix, but rather to the physical repositioning of the fetus as it prepares for labor.

C) Ballottement:
Ballottement is the correct term for the movement of the fetus that can be felt by the provider when upward pressure is applied to the cervix. This technique involves a gentle tapping or pushing on the cervix, causing the fetus to rise and then "bounce" back. This is a probable sign of pregnancy, typically noticeable between 16 and 18 weeks gestation.

D) Chadwick's sign:
Chadwick’s sign refers to the bluish discoloration of the cervix, vagina, and vulva due to increased blood flow and is often an early sign of pregnancy. It does not relate to the movement of the fetus felt by the provider, but rather to changes in the color of the genital tissues.