A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem?

A. Candidiasis:

Candidiasis is caused by an overgrowth of the fungus Candida albicans in the vagina. It typically presents with symptoms such as thick, white vaginal discharge (resembling cottage cheese), itching, and discomfort during sexual intercourse (dyspareunia). This option is the most likely diagnosis based on the client's symptoms.

B. Genital herpes simplex:

Genital herpes simplex is caused by the herpes simplex virus (HSV). It presents with symptoms such as painful, fluid-filled blisters or sores in the genital area. While genital herpes can cause vaginal discharge, the discharge is typically clear or cloudy, not thick and white as described in the scenario.

C. Trichomoniasis:

Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. It commonly presents with symptoms such as a frothy, yellow-green vaginal discharge, itching, and discomfort during urination or sexual intercourse. The discharge is typically not described as thick and white.

D. Bacterial vaginosis:

Bacterial vaginosis results from an imbalance of bacteria in the vagina, with a decrease in beneficial bacteria and an overgrowth of harmful bacteria. It presents with symptoms such as a thin, grayish-white vaginal discharge with a fishy odor. While bacterial vaginosis can cause vaginal discomfort, the discharge is not typically described as thick and white.

A. Attach a sign above her bed to have BP, IV lines, and lab work in her right arm.

- This option is not appropriate because after a right-sided modified-radical mastectomy, it's generally contraindicated to use the affected arm (right arm in this case) for blood pressure measurements, IV lines, or blood draws. This is because such procedures can impede lymphatic drainage and increase the risk of lymphedema. Therefore, the unaffected arm is typically preferred for these purposes to reduce the risk of complications.

B. Encourage her to turn, cough, and deep breathe at frequent intervals.

- While turning, coughing, and deep breathing are essential postoperative nursing interventions to prevent respiratory complications such as pneumonia, they are not specific to the unique needs of a woman who has undergone a mastectomy. These interventions are more focused on general postoperative care rather than addressing the specific concerns related to mastectomy, such as lymphedema management.

C. Position her right arm below heart level.

- This is the correct choice. Positioning the right arm below heart level helps reduce swelling and promotes lymphatic drainage, particularly after surgery involving the lymph nodes, as in a mastectomy. This positioning aids in preventing complications such as lymphedema and supports optimal circulation and fluid balance in the affected arm.

D. Ask the client how she feels about having her breast removed.

- While emotional support and addressing the client's feelings are important aspects of care for a woman who has undergone a mastectomy, this intervention is more appropriate during psychosocial assessment and counseling sessions, rather than immediately postoperatively. At this stage, the focus should be primarily on physical recovery and addressing immediate postoperative needs, such as pain management and prevention of complications like lymphedema. Emotional support can certainly be provided, but it should not be the primary intervention immediately following surgery.