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• Pulse of 105 beats/minute – Both mastitis and endometritis
  Tachycardia (heart rate >100 bpm) is a systemic response to infection and inflammation, which can occur in both mastitis and endometritis. In mastitis, infection in the breast tissue triggers a systemic inflammatory response, while in endometritis, uterine infection can cause sepsis-related tachycardia.
• Feeling chilled, achy, and fatigued – Both mastitis and endometritis
  Both conditions can cause systemic flu-like symptoms, including chills, body aches, and fatigue, as the body mounts an immune response. Mastitis leads to generalized malaise due to localized infection and inflammation in the breast, while endometritis causes uterine infection, which can spread if untreated.
• Baby fed pumped breast milk – Mastitis
  Mastitis often develops due to milk stasis when the breasts are not fully emptied. The client was away from the baby for several hours while feeding pumped milk, which may have led to incomplete drainage of the breast, increasing the risk of bacterial overgrowth and mastitis.
• Pain rating of 4 on a 0 to 10 scale – Mastitis
  Pain in mastitis is usually localized to the affected breast, presenting as a red, firm, warm area. The uterine pain in endometritis is generally more cramp-like and associated with uterine tenderness, rather than a focal area of pain like in mastitis.
• Foul-smelling lochia rubra at 2 weeks postpartum – Endometritis
  Lochia should transition from rubra (red) to serosa (pink-brown) to alba (white/yellow) within 2 weeks postpartum. Foul-smelling, persistent lochia rubra is a hallmark sign of endometritis, indicating bacterial overgrowth in the uterus.
• Temperature of 101.2° F (38.4°C) – Both mastitis and endometritis
  Fever is a key symptom of both mastitis and endometritis as the body responds to infection. Mastitis causes localized breast infection with systemic symptoms, while endometritis results in uterine infection and systemic inflammatory response.

• Plugged duct: A plugged duct occurs when milk is not effectively drained from the breast, leading to milk stasis and inflammation. If untreated, it can progress to mastitis, an infection caused by bacterial overgrowth in stagnant milk. The client's history of missing a feeding while shopping increases the likelihood of milk stasis, making a plugged duct the most likely cause of mastitis.
• Breast abscess: A breast abscess is a collection of pus that forms when mastitis is left untreated or does not respond to antibiotics. Unlike mastitis, an abscess is typically fluctuant (soft and fluid-filled), extremely tender, and may require drainage. Since the client’s mastitis symptoms have just begun, an abscess is unlikely at this stage.
• Engorgement : Breast engorgement occurs when the breasts overfill with milk, causing swelling and discomfort. While engorgement can increase the risk of mastitis, it is not an infection itself and does not directly cause mastitis unless milk stasis leads to bacterial overgrowth. Engorgement is bilateral, whereas mastitis is usually unilateral with localized redness, warmth, and fever.
• Nipple trauma with cracked skin: Cracked nipples can allow bacteria to enter the breast, increasing the risk of infection. However, mastitis is primarily caused by milk stasis, not just nipple trauma. In this client, there is no mention of nipple cracks or bleeding, making this a less likely cause.
• Firm, red, warm area on the right breast: A firm, red, warm, and tender area on the breast is a hallmark symptom of mastitis, indicating localized inflammation and infection. The presence of systemic symptoms (fever, chills, fatigue) further supports mastitis rather than another breast condition.
• Pus draining from the nipple: Pus or fluctuance (fluid-filled swelling) suggests a breast abscess, not mastitis. While untreated mastitis can lead to an abscess, this client’s symptoms do not indicate a severe or advanced infection requiring drainage.
• Generalized swelling of the entire breast: Severe engorgement can cause generalized swelling, but mastitis typically presents as a localized, inflamed area rather than affecting the entire breast. Engorgement also does not cause fever or systemic illness, which are present in mastitis.
• Pain that worsens with cold compresses: Cold compresses reduce inflammation and discomfort in mastitis. If cold worsens pain, it may suggest Raynaud’s phenomenon of the nipple, which is not related to mastitis. Mastitis pain is relieved with warmth, massage, and frequent breastfeeding.

• 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.

Calculate the total daily dose:

Total daily dose (mg) = Weight (kg) x Dosage (mg/kg/day)

= 25 kg x 10 mg/kg/day

= 250 mg/day

Calculate the volume to administer per dose:

Volume to administer (mL) = Desired dose (mg) / Available concentration (mg/mL)

Available concentration = 50 mg / 5 mL

= 10 mg/mL

Volume to administer (mL) = 250 mg / 10 mg/mL

= 25 mL

The nurse should administer 25 mL per dose.