The nurse is assessing a one hour old newborn delivered vaginally after a 15 hour labor. Upon palpation of the head, the nurse notices swelling of the tissue over the presenting part of the infant's head, crossing the suture lines. How would the nurse document this finding?

A) Rubra, serosa, alba:
The normal progression of lochia, the vaginal discharge after childbirth, follows a predictable sequence of stages. Lochia rubra is the initial stage, occurring within the first few days postpartum. It is bright red and consists primarily of blood, tissue, and debris from the placenta. After 3-4 days, the discharge changes to lochia serosa, which is pinkish-brown and contains a mixture of blood, serous fluid, and mucous. After 10-14 days, it progresses to lochia alba, which is white or pale yellow and consists mostly of leukocytes (white blood cells), mucus, and epithelial cells. This is the expected progression, which marks the natural healing process after childbirth.

B) Rubra, alba, serosa:
This order is incorrect because lochia serosa comes before lochia alba in the normal sequence. Lochia alba occurs after lochia serosa, not before. This progression would not accurately reflect the typical stages of lochia.

C) Serosa, alba, rubra:
This sequence is incorrect as lochia rubra is the first stage, not lochia serosa. The initial discharge following childbirth is always red and blood-tinged, which is lochia rubra. Serosa and alba come later in the progression, so this order does not follow the correct timeline.

D) Alba, rubra, serosa:
This order is completely incorrect. Lochia rubra (red blood discharge) is the first stage, not lochia alba (white discharge). After childbirth, rubra occurs first, followed by serosa, and then finally alba. This sequence does not reflect the normal postpartum discharge process.

A) Soft, nontender, colostrum is present:
In the early postpartum period, specifically on day 1, the woman is still in the process of transitioning from producing colostrum (a thick, yellowish fluid rich in antibodies) to mature breast milk. The colostrum may be present, but the breasts are typically not soft and nontender. Instead, they are more likely to be swollen and tender as the milk production ramps up. Therefore, this is not the typical finding on day 1 postpartum.
B) Swollen, warm, and tender upon palpation:
This is the expected finding on day 1 postpartum, especially for a primiparous woman. After childbirth, the breasts begin the transition from producing colostrum to mature breast milk. The increased blood flow and milk production cause the breasts to become swollen, warm, and tender to the touch. This condition is often referred to as engorgement, which is common within the first few days after delivery, particularly in breastfeeding mothers. Engorgement usually peaks around day 3 but may begin to occur slightly earlier, as the body adjusts to milk production.

C) Leakage of milk at let-down:
This finding is more typical of a woman who is further along in the postpartum period, usually after her milk has transitioned from colostrum to mature milk. Milk let-down and the associated leakage typically occur later, often after a few days (around day 3 or later). On day 1, the milk supply is still establishing itself, and leakage is less common.

D) A few blisters and bruises on each areola:
Blisters and bruises on the areola could indicate improper latch or trauma from breastfeeding. This is not a typical or expected finding in a woman who is only 1 day postpartum. If this occurs, the nurse should assess the infant’s latch and the breastfeeding technique to prevent further complications. Such findings should be addressed promptly, but they are not considered normal on day 1.