A client presents to labor and delivery at 36-weeks gestation reporting bright red vaginal bleeding without contractions. Which result should the nurse review first in the client's medical record?

Rationale:

A. Monitor the stool and urine output of the neonate for the last 24 hours: Monitoring elimination patterns is important to assess hydration and feeding adequacy. However, a weight loss of approximately 6% from birth is within the expected physiologic range and does not require immediate intervention.

B. Inform and assure the mother that this is a normal weight loss: Newborns typically lose 5–10% of their birth weight during the first 3–5 days due to fluid shifts and limited initial intake. The nurse’s priority is to reassure the mother, explain that this is expected, and continue supporting regular feeding.

C. After verifying the accuracy of the weight, notify the healthcare provider: Notifying the healthcare provider is necessary if the weight loss exceeds 10% of birth weight or if there are signs of dehydration. In this case, the loss is within the normal range.

D. Encourage the mother to increase frequency of breastfeeding: Increasing feeding frequency is important if the infant shows inadequate intake or excessive weight loss. Since the weight loss is physiologic and expected, routine feeding patterns can continue.

Rationale:

A. Wear a supportive bra at all times: Wearing a well-fitting, supportive bra helps relieve pressure on engorged breasts and provides comfort while maintaining proper breast support. It can reduce swelling, prevent tissue damage, and make breastfeeding or pumping more manageable during periods of overfull breasts.

B. Take two acetaminophen to relieve the discomfort: Acetaminophen may help reduce pain, but it does not address the underlying cause of engorgement or prevent worsening discomfort. Medication alone is not sufficient as a primary strategy for managing engorged breasts.

C. Use breast cream to help prevent discomfort: Breast creams are designed to prevent nipple soreness or cracking but do not alleviate discomfort from breast engorgement. This intervention would not directly reduce swelling or pressure in overfull breasts.

D. Put a heating pad on the breasts while they are engorged: Applying heat to engorged breasts can worsen swelling by increasing blood flow and may intensify discomfort. Instead, cold compresses before feeding or gentle massage toward the nipple during feeding is more effective in relieving engorgement.