Exhibits

The nurse determines the need to perform more of an assessment based on the client's symptoms.

Based on the new assessment findings, choose the most likely options for the information missing from the statements by selecting from the lists of options provided.

Based on the assessment findings, the priority diagnosis suspected is 

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This diagnosis places the client at risk of

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A. Obtain blood cultures. Blood cultures are not required for diagnosing or managing herpes simplex virus (HSV) in pregnancy. While neonatal herpes can lead to systemic infection, cultures are typically performed on the newborn only if infection is suspected after birth. The priority is preventing vertical transmission.
B. Administer penicillin. Penicillin is used for bacterial infections, such as Group B Streptococcus (GBS) or syphilis, but it is ineffective against HSV, which is a viral infection. Antiviral medications like acyclovir are used to suppress HSV outbreaks during pregnancy, but once active lesions are present at term, cesarean delivery is required.
C. Prepare for a cesarean section. Active genital herpes at the time of delivery poses a significant risk of neonatal herpes, which can cause severe complications such as encephalitis, sepsis, or death. To prevent direct contact with the virus, cesarean section is recommended if there are active lesions or prodromal symptoms at the time of labor or rupture of membranes.
D. Cover the lesion with a dressing. Covering herpes lesions does not prevent transmission during vaginal birth, as the virus can still be present in vaginal secretions. The most effective way to prevent neonatal herpes is to avoid exposure through cesarean delivery.

• Mastitis: Mastitis is an infection of breast tissue that occurs when milk stasis leads to bacterial overgrowth, usually caused by Staphylococcus aureus. The client's firm, red, warm area on the breast, fever (101.2°F), chills, body aches, and fatigue all strongly indicate mastitis rather than other breast conditions.
• Engorgement: Engorgement occurs when the breasts overfill with milk, leading to swelling and tenderness. However, engorgement typically affects both breasts, does not cause fever or flu-like symptoms, and resolves with regular breastfeeding or pumping.
• Blocked milk duct: A clogged duct occurs when milk flow is obstructed, leading to a tender lump in the breast. While a blocked duct can progress to mastitis, it does not cause fever or systemic symptoms unless infection develops. The presence of fever and flu-like symptoms in this client suggests mastitis, not just a blocked duct.
• Inflammatory breast cancer: This rare but aggressive form of breast cancer causes redness, swelling, and skin thickening, but it is not associated with fever or acute symptoms like mastitis. It does not develop suddenly but rather progresses over time, making mastitis the more likely diagnosis in this case.
• Abscess: If mastitis is not treated promptly, it can lead to a breast abscess, a localized collection of pus requiring drainage. Signs of progression to an abscess include fluctuant swelling, worsening pain, and persistent fever despite antibiotic treatment.
• Breastfeeding intolerance: Mastitis can cause temporary discomfort during breastfeeding, but it does not lead to true breastfeeding intolerance. In fact, continued breastfeeding helps resolve mastitis by improving milk drainage.
• Nipple thrush: Nipple thrush (Candida infection) causes burning pain and white patches in the infant’s mouth but is not a complication of mastitis, which is bacterial, not fungal.
• Postpartum haemorrhage: Postpartum hemorrhage is caused by uterine atony, retained placenta, or coagulation disorders, not mastitis. Mastitis is localized to the breast and does not affect uterine bleeding.