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

This notation indicates three pregnancies (G3), one term birth (T1), two preterm births (P2), one abortion (A1), and three living children (L3). While the number of living children is correct, the total number of pregnancies is underestimated by excluding the current pregnancy.

Choice B rationale

This notation accurately reflects four pregnancies (G4: the elective abortion, the daughter, the twins, and the current pregnancy), one term birth (T1: the daughter born at 40 weeks), two preterm births (P2: the twin boys born at 34 weeks), one abortion (A1: the elective abortion), and three living children (L3: the daughter and the twin boys).

Choice C rationale

This notation indicates three pregnancies (G3), one term birth (T1), one preterm birth (P1), one abortion (A1), and three living children (L3). The number of preterm births is incorrect, as there were two preterm births (the twins).

Choice D rationale

This notation indicates four pregnancies (G4), one term birth (T1), one preterm birth (P1), one abortion (A1), and three living children (L3). The number of preterm births is incorrect, as there were two preterm births (the twins).

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.