A primiparous client was induced at 41-weeks gestation with misoprostol and oxytocin. She gave birth vaginally 4 days ago, and her prenatal course and delivery were uncomplicated. She was discharged home on day two with her newborn and has been breastfeeding around the clock. Discharge prescription included ferrous sulfate 325 mg PO twice daily. Client called her healthcare provider (HCP) this morning with fatigue, new onset of headache that was not relieved with ibuprofen, nausea, dizziness, weakness, and seeing “flashing lights.”. Client was instructed to come to the hospital for evaluation.

Choice A rationale: Hemoglobin of 10.4 g/dL is slightly below the normal range for non-pregnant women (12-16 g/dL) but may be acceptable postpartum. Mild anemia can cause fatigue but doesn't explain the new-onset headache, dizziness, or elevated blood pressure.

Choice B rationale: Platelet count of 150,000/mm³ is within the normal range (150,000-450,000/mm³). Thrombocytopenia would be a concern if platelets were below 150,000/mm³, as it can cause bleeding, but it doesn't correlate with the client's symptoms.

Choice C rationale: New-onset headache, especially unrelieved by ibuprofen, is concerning. Postpartum preeclampsia can present with a severe headache. The headache, combined with elevated blood pressure, requires further investigation for potential complications like cerebral edema or hypertensive encephalopathy.

Choice D rationale: Vomiting yellow fluid may indicate gastrointestinal distress or bile. In the context of right upper quadrant pain and elevated blood pressure, it raises concerns for conditions like HELLP syndrome or liver involvement. Further evaluation is needed to rule out these possibilities.

Choice E rationale: Right upper quadrant pain can be a symptom of postpartum preeclampsia or HELLP syndrome, where liver enzymes are elevated. Pain in this area combined with other symptoms like headache, nausea, and elevated blood pressure warrants further investigation.

Choice F rationale: Seeing flashing lights is a potential sign of visual disturbances related to severe hypertension or preeclampsia. It can be an indication of impending eclampsia or other complications like retinal detachment or cerebral edema. This symptom must be promptly evaluated.

Choice G rationale: Elevated blood pressure (169/104 mm Hg) is a critical finding. Normal postpartum blood pressure should be below 140/90 mm Hg. Severe hypertension postpartum can lead to complications like preeclampsia, eclampsia, or stroke. Immediate medical evaluation is required.

Choice H rationale: Iron supplementation is common postpartum to address mild anemia and restore iron levels depleted during pregnancy and delivery. While important for recovery, it does not explain the new-onset headache, elevated blood pressure, or other symptoms reported by the client.

Acidemia: Acidemia refers to an abnormal acidity in the blood (pH < 7.35). Prolonged abnormal FHR patterns can indicate insufficient oxygen delivery to the fetus, leading to anaerobic metabolism and the production of lactic acid, causing acidemia. The normal fetal pH is around 7.30-7.35.

Hypoxemia: Hypoxemia is a reduced level of oxygen in the blood. Abnormal FHR patterns may signal that the fetus is not receiving adequate oxygen, potentially due to cord compression, placental insufficiency, or other factors affecting oxygen transfer. Normal oxygen saturation for a fetus is generally around 30-70%.

Hypoxia: Hypoxia is a condition where there is insufficient oxygen available to meet the metabolic needs of the fetus. Abnormal FHR patterns can indicate ongoing or impending hypoxia, which can lead to severe fetal distress and compromise. It is crucial to monitor and address such conditions promptly.

Rationale for Incorrect Answers:

Hypoglycemia: Hypoglycemia refers to low blood glucose levels (typically < 45 mg/dL in newborns). Abnormal FHR patterns are not directly associated with changes in glucose metabolism. Rather, hypoglycemia in neonates is often related to maternal diabetes, prematurity, or other metabolic disturbances.

Meconium Stool: Meconium-stained amniotic fluid is a possible indicator of fetal distress but is not a direct result of abnormal FHR patterns. Meconium passage may be associated with post-term pregnancy, fetal hypoxia, or other factors, but the direct consequences of abnormal FHR patterns are more specifically related to oxygenation and acid-base status.

Maternal Hypotension: Maternal hypotension, or low blood pressure (typically < 90/60 mm Hg), is a maternal condition that can affect fetal well-being if severe and prolonged. However, it is not a direct result of abnormal FHR patterns. Instead, maternal hypotension can contribute to abnormal FHR by impairing uteroplacental perfusion.