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

Wrapping the baby in warmed blankets addresses heat loss through conduction (direct contact with a cooler surface) and radiation (heat transfer to cooler surroundings). While helpful for maintaining warmth, it does not directly prevent heat loss from convection.

Choice B rationale

Convection is the loss of heat to cooler air currents moving across the skin surface. A blowing fan increases the rate of convective heat loss by continuously moving cooler air over the newborn. Moving the infant away from a blowing fan minimizes this heat transfer mechanism, thus preventing heat loss from convection.

Choice C rationale

Drying the baby after a bath primarily prevents heat loss through evaporation, as the evaporation of water from the skin surface cools the body. While important for thermoregulation, it does not directly address convective heat loss.

Choice D rationale

Placing the baby in a warmer, such as a radiant warmer, primarily prevents heat loss through radiation by providing a warm surface that emits infrared heat towards the infant. It also helps maintain the ambient air temperature, indirectly reducing convective heat loss, but moving away from a direct air current is the most direct way to prevent convection.

Choice A rationale: Weight loss

Weight loss during pregnancy, especially in the second trimester, is unexpected unless there is a medical condition such as hyperemesis gravidarum or other nutritional deficiencies. While mild weight fluctuations can occur, a consistent loss of weight rather than gradual gain suggests inadequate caloric intake due to persistent vomiting and dehydration.

Choice B rationale: Breast tenderness

Breast tenderness is a common and expected physiological change during pregnancy due to hormonal fluctuations, particularly increased estrogen and progesterone levels. It is not considered abnormal or unexpected at this stage of pregnancy.

Choice C rationale: Heart rate

A heart rate of 116/min is unexpected, as it is above the normal range for adults (typically 60–100/min). Pregnancy can cause a mild increase in heart rate, but tachycardia above 110/min may indicate dehydration, anemia, or electrolyte imbalance, all of which can stem from excessive vomiting and fluid loss.

Choice D rationale: Vomiting

While occasional nausea and vomiting (morning sickness) can be expected in early pregnancy, persistent vomiting up to eight times daily and symptoms of dehydration (dry mucosa, poor skin turgor, positive ketones in urine) raise concern for hyperemesis gravidarum, a more severe form of pregnancy-related nausea and vomiting.

Choice E rationale: Nasal congestion

Nasal congestion is common during pregnancy due to increased blood volume and vascular changes affecting the nasal mucosa. It is not unexpected and does not indicate a complication.

Choice F rationale: Respiratory rate

A respiratory rate of 20/min falls within the normal range for adults (typically 12–20/min), making it an expected finding.