A nurse is assessing a 1-hour-old newborn.
Which of the following findings should the nurse report to the provider?

Choice A rationale

Feeding from the affected breast is crucial for promoting milk drainage and preventing milk stasis, which can exacerbate mastitis. Emptying the breast, even if painful, helps to clear the blocked ducts and reduce the bacterial load. Discontinuing feeding from the affected breast could lead to engorgement and worsening of the infection, hindering recovery.

Choice B rationale

Pumping and discarding milk is not recommended for mastitis. The milk from a breast with mastitis is generally safe for the infant, and the act of pumping helps to empty the breast and facilitate drainage, similar to direct breastfeeding. Discarding the milk unnecessarily deprives the infant of nutrition and can contribute to decreased milk supply.

Choice C rationale

Applying moist heat to the affected breast can significantly alleviate discomfort and promote milk flow by causing vasodilation and encouraging ductal patency. This helps to reduce inflammation, improve circulation, and facilitate the drainage of milk from the breast, which is essential for resolving the infection and reducing pain.

Choice D rationale

Maintaining adequate hydration is important for overall health, especially during lactation. However, a specific fluid intake of exactly 1,500 milliliters per day is not the primary or most effective intervention for mastitis. While hydration supports milk production, the core interventions for mastitis focus on milk drainage, pain management, and often antibiotic therapy.

Choice A rationale: Stopping breastfeeding is not indicated in postpartum infections unless the infection is a contraindication such as HIV or active tuberculosis. Breastfeeding promotes uterine contraction by releasing oxytocin, which helps reduce bleeding and promotes healing. Additionally, breast milk provides immunological benefits to the newborn. The client’s infection appears localized to the uterus (endometritis), and there is no evidence breastfeeding worsens maternal infection or neonatal risk here.

Choice B rationale: Initiating broad-spectrum antibiotics is scientifically appropriate for suspected postpartum endometritis, especially with fever >38°C, tachycardia, foul-smelling lochia, and abdominal tenderness. These antibiotics target polymicrobial infections commonly involving aerobic and anaerobic bacteria, preventing progression to sepsis. Timely antibiotic therapy reduces maternal morbidity and accelerates recovery. Normal temperature is 36.5–37.5°C; this client’s rising fever to 38.9°C indicates infection requiring treatment.

Choice C rationale: Airborne isolation precautions are unnecessary because common postpartum infections such as endometritis are not transmitted via airborne routes but rather by endogenous flora or direct contamination. Airborne pathogens include tuberculosis, varicella, and measles, none of which are suggested by this client’s presentation or history. Implementing unnecessary airborne precautions wastes resources and increases patient isolation without scientific benefit.

Choice D rationale: Strict bedrest is not routinely indicated in postpartum infections unless severe systemic illness is present. Early mobilization improves circulation, reduces risk of venous thromboembolism, and promotes pulmonary function, especially when respiratory rate is elevated at 24/min. The client is alert and breastfeeding, suggesting stable condition. Prolonged immobility increases risks without benefits in mild-to-moderate infection management.