A client is ordered digoxin 0.25mg po. daily. On hand is a liquid in a dropper bottle labeled 500mcg/10mL. How many milliliters will be administered?

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) Offering opioids followed by topical treatment:
While opioids can be effective for pain, they are typically reserved for more severe pain and are not the first line of treatment for the moderate pain commonly experienced postpartum, especially after a first-degree laceration. A stepwise approach emphasizes starting with less potent options and progressing as needed, so offering opioids first is not appropriate here.

B) Offering mindfulness only for pain:
While mindfulness and other non-pharmacological techniques can be helpful for pain management, offering only mindfulness as the sole approach may not adequately address the client's pain, especially in the early postpartum period. A stepwise approach typically involves combining pharmacological and non-pharmacological methods to achieve effective pain relief, so relying only on mindfulness is not the most effective strategy for this situation.

C) Giving the highest dose of opioids to make sure to eliminate the pain:
Stepwise pain management involves starting with the least invasive and least potent option, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and escalating treatment if necessary. Using high doses of opioids first can lead to unnecessary side effects and risks, especially when less potent options would suffice.

D) Starting with ibuprofen for pain management and adding cold therapy for additional relief:
This is an example of a stepwise approach to pain management. Starting with ibuprofen, an NSAID, addresses inflammation and mild to moderate pain effectively, which is appropriate for a first-degree laceration. Cold therapy can be added for additional relief, as it helps reduce swelling and numb the area, which can further reduce discomfort. This combination of pharmacological and non-pharmacological treatments follows the principle of starting with less potent options and adding more if needed, making it the best choice.