A nurse is caring for a 28-year-old female client who is 2 days postpartum in the postpartum unit following a cesarean birth. For each finding below, click to specify if the finding is consistent with the disease process of lactational mastitis, postpartum endometritis, or postpartum hemorrhage. Each finding may support more than one disease process.

Exhibits

For each finding below, click to specify if the finding is consistent with the disease process of lactational mastitis, postpartum endometritis, or postpartum hemorrhage. Each finding may support more than one disease process.

Choice A rationale

A dipstick value of 3+ for protein in the urine is a significant indicator of proteinuria, a key diagnostic criterion for preeclampsia. Preeclampsia is characterized by new-onset hypertension and proteinuria or other signs of end-organ damage in a previously normotensive pregnant woman. A 3+ protein level suggests substantial protein spillage into the urine, necessitating immediate attention to assess the severity of preeclampsia and prevent potential complications for both the mother and the fetus. Normal urine protein is typically negative to trace amounts.

Choice B rationale

Pitting pedal edema at the end of the day can be a common finding in pregnancy due to increased blood volume and pressure on the veins in the legs. While edema can be associated with preeclampsia, it is not a primary diagnostic criterion and can occur in normal pregnancies. Therefore, isolated pedal edema without other signs of preeclampsia is less concerning than significant proteinuria.

Choice C rationale

A blood pressure reading of 138/86 mm Hg is mildly elevated and falls within the range for stage 1 hypertension. While hypertension is a diagnostic criterion for preeclampsia, this isolated reading without a significant increase from baseline or other preeclampsia symptoms may not be the most urgent concern compared to significant proteinuria. Preeclampsia diagnosis requires a blood pressure of ≥140 mm Hg systolic or ≥90 mm Hg diastolic on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive woman.

Choice D rationale

A weight gain of 0.5 kg (approximately 1.1 pounds) over two weeks is within the expected range for weight gain during pregnancy. While rapid or excessive weight gain can be a sign of fluid retention associated with preeclampsia, a modest gain of 0.5 kg over two weeks is not a primary indicator of the condition and is less concerning than significant proteinuria.

Choice A rationale

Accumulation of flatulence can cause abdominal discomfort after a cesarean birth, but it does not directly stimulate uterine contractions leading to afterpains. Afterpains are specifically related to the involution of the uterus, not gastrointestinal motility.

Choice B rationale

Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterotonic hormone that causes the uterus to contract to its pre-pregnant size. These contractions are experienced as afterpains, especially in multiparous women whose uterine muscles may have less tone.

Choice C rationale

While some medications administered after birth can have side effects, severe cramps or afterpains are primarily a physiological response to uterine involution and the hormonal changes associated with breastfeeding, rather than a direct adverse effect of medication.

Choice D rationale

Healing of the abdominal incision after a C-section causes incisional pain, which is distinct from the cramping sensation of afterpains. Afterpains are specifically due to uterine contractions, not the healing process of the abdominal wall.