Postpartum

The nurse cares for a client who gave birth an hour ago to a 9-lb (4.1-kg) newborn. The client's lochia is heavy with large clots, and the fundus remains boggy after fundal massage and an oxytocin bolus. Which prescription from the health care provider should the nurse question? Click on the exhibit button for additional information. 1. Administer 0.2-mg methylergonovine IM 2. Administer 800-mcg misoprostol rectally 3. Collect a hemoglobin and hematocrit STAT 4. Initiate second IV line with 18-gauge needl.

1. Administer 0.2-mg methylergonovine IM Postpartum hemorrhage (PPH) due to uterine atony is exacerbated by conditions that cause overdistension of the uterus (eg, macrosomia, multiple gestation, multiparity). If excessive bleeding persists after initial interventions (eg, firm fundal massage, oxytocin bolus), second-line uterotonic drugs (eg, carboprost, methylergonovine, misoprostol) may be given. Methylergonovine [Methergine] is contraindicated for clients with high blood pressure (eg, preeclampsia, preexisting hypertension) because the primary mechanism of action is vasoconstriction. If administered to a hypertensive client, it can lead to further blood pressure elevation, seizure, or stroke (Option 1). Educational objective:Postpartum hemorrhage due to uterine atony may require uterotonic drug administration to reverse excessive bleeding. Methylergonovine causes vasoconstriction and is contraindicated for clients with hypertension due to the risk of seizure or stroke.

The postpartum nurse is caring for a client 8 hours after an uncomplicated cesarean birth. Which of the following interventions should the nurse include in the client's plan of care to reduce the risk of thrombus formation? Select all that apply. 1. Administer analgesics as needed 30 minutes prior to ambulation 2. Assist the client to ambulate starting on the third postoperative day 3. Instruct the client to perform leg exercises hourly while in bed 4. Maintain sequential compression devices on the lower extremities 5. Request a prescription for daily aspirin until the client is discharged

1. Administer analgesics as needed 30 minutes prior to ambulation 3. Instruct the client to perform leg exercises hourly while in bed 4. Maintain sequential compression devices on the lower extremities Deep venous thrombosis (DVT) describes the formation of a thrombus (blood clot) that impedes blood flow in a deep vein and may progress to life-threatening pulmonary embolism (PE). Thrombus formation is associated with venous stasis (blood pooling), which may occur during or after surgery due to immobility. In addition, blood hypercoagulability, a physiologic adaptation during pregnancy, also increases the risk of postpartum thrombus formation. The nurse should emphasize interventions that promote blood flow and venous return, especially for clients recovering from cesarean birth. Interventions to prevent postpartum thrombus formation include: Promoting early and frequent ambulation by ensuring adequate pain control (eg, administer analgesic 30 min before activity) (Option 1) Instructing the client to perform leg exercises (eg, dorsiflexion, plantar flexion) hourly (Option 3) Maintaining prescribed sequential compression devices during sedentary activities (Option 4) (Option 2) The nurse should have clients ambulate (with assistance) as soon as possible after surgery (ie, usually on the first postoperative day) if they are in stable condition and can support themselves while standing. (Option 5) Anticoagulant therapy with heparin, not aspirin, is indicated for postpartum DVT/PE prevention in clients with additional risk factors (eg, history of DVT). Educational objective:Deep venous thrombosis describes the formation of a thrombus that impedes blood flow in a deep vein and may progress to life-threatening pulmonary embolism. Interventions to prevent postpartum thrombus formation include promoting early ambulation by ensuring adequate pain control, instructing the client to perform leg exercises, and maintaining sequential compression devices on the lower extremities.

A nurse is caring for a postpartum client who is breastfeeding and has been diagnosed with mastitis of the right breast. Which of the following instructions should the nurse include in client teaching? Select all that apply. 1. Apply warm compresses to breast 2. Discontinue breastfeeding until symptoms resolve 3. Increase oral fluid intake 4. Take ibuprofen as needed for pain 5. Wear a tight-fitting bra as much as possible

1. Apply warm compresses to breast 3. Increase oral fluid intake 4. Take ibuprofen as needed for pain Lactational mastitis (infection and inflammation of breast tissue) may result from inadequate milk duct drainage or poor breastfeeding technique. Bacteria from the infant's nasopharynx or mother's skin can enter the nipple, especially if it is damaged, and multiply in stagnant milk. Manifestations include fever, muscle aches, and breast pain and inflammation (eg, warmth, redness, edema). Staphylococcus aureus is the most common causative organism and requires antibiotic treatment (eg, dicloxacillin, cephalexin). In addition, the nurse should encourage the client to: Continue breastfeeding frequently (ie, every 2-3 hr) to ensure adequate milk drainage. Ensure proper breastfeeding technique (eg, alternate newborn feeding positions, proper latch). Apply warm compresses and massage the breast to facilitate complete emptying (Option 1). Cool compresses can also be used between breastfeeding as needed for comfort. Ensure adequate rest, nutrition, and hydration (Option 3). Relieve pain and inflammation with analgesics compatible with breastfeeding (eg, acetaminophen, ibuprofen) (Option 4). Wash hands before and after feeding. Educational objective:Treatment for lactational mastitis includes antibiotic therapy, continued breastfeeding, breastfeeding support (eg, proper latch technique), warm compresses, massage, adequate nutrition and hydration, and appropriate analgesics (eg, ibuprofen, acetaminophen).

A nurse is caring for a client following delivery of a stillborn infant. Which actions should the nurse take? Select all that apply. 1. Ask the parents if they would like to help bathe the infant 2. Discourage the parents from naming the infant 3. Discuss the importance of organ donation with the parents 4. Encourage the parents and family members to hold the infant 5. Offer to obtain handprints, footprints, and photographs of the infant

1. Ask the parents if they would like to help bathe the infant 4. Encourage the parents and family members to hold the infant 5. Offer to obtain handprints, footprints, and photographs of the infant. Intrauterine fetal demise, or stillbirth, is the birth of an infant who is not alive. The nurse can assist with the perinatal bereavement process by using therapeutic communication, encouraging the parents and family to hold the infant, and providing privacy. Parents and family members may wish to help bathe and dress the infant, and should be encouraged to view and hold the body before discharge to the funeral home (Options 1 and 4). The nurse should offer to obtain handprints and footprints, cut a lock of the infant's hair, and photograph the infant (Option 5). These keepsakes are often precious mementos for grieving families who must leave the hospital without a child. However, none of these actions should be forced if the parents decline. Educational objective: Intrauterine fetal demise (ie, stillbirth) is the birth of an infant who is not alive. The nurse should encourage family members to hold and name the infant. Mementos (eg, hand/foot prints, photographs) should be made for the family to keep. However, none of these actions should be forced if the parents decline.

A nurse is caring for a client who had a vaginal birth 2 hours ago. The client has saturated a perineal pad in 20 minutes. During assessment, the nurse notices that the client has a boggy fundus that is deviated to the right and slightly above the umbilicus. Which intervention should the nurse perform first? 1. Assist client to use the bedpan to void 2. Begin oxytocin IV infusion at 125 milliunits/min 3. Obtain a complete blood count 4. Start oxygen delivery at 10 L/min via nonrebreather facemask

1. Assist client to use the bedpan to void Postpartum vaginal bleeding that saturates aperineal pad in <1 hour is considered excessive. This client saturated a perineal pad in 20 minutes. Based on the nurse's assessment, the boggy fundus indicates uterine atony. The fundus is also elevated above the umbilicus and deviated to the right, indicating a distended bladder. Bladder distension prevents the uterus from contracting sufficiently to control bleeding at the previous placental site. The client should be assisted to void to correct the bladder distension (Option 1). The nurse should then perform fundal massage. Educational objective:Excessive postpartum bleeding is most commonly caused by uterine atony. The nursing priority for uterine atony associated with bladder distension is to assist the client with voiding and then perform fundal massage and other interventions as needed to control excessive bleeding.

The nurse reviews the chart of a client who gave birth 4 hours ago. Which contributing factor indicates that the client has an increased risk of postpartum hemorrhage? 1. Infant birth weight of 9 lb 2 oz (4139 g) 2. Labor and birth without pain medication 3. Labor that lasted 8 hours 4. Third stage of labor lasting 20 minutes

1. Infant birth weight of 9 lb 2 oz (4139 g) Postpartum hemorrhage (PPH) is usually defined as maternal blood loss of >500 mL after a vaginal birth or >1000 mL after a cesarean birth. Uterine atony, characterized by a soft, "boggy," and poorly contracted uterus, is the most common cause of early PPH (occurring ≤24 hours after birth). Delayed PPH (>24 hours after birth) usually results from retained placental fragments associated with a long third stage of labor (ie, time from birth of baby to expulsion of placenta, lasting >30 minutes). Risk factors for PPH include: History of PPH in prior pregnancy Uterine distension due to:Multiple gestationPolyhydramnios (ie, excessive amniotic fluid)Macrosomic infant (≥8 lb 13 oz [4000 g]) (Option 1) Uterine fatigue (labor lasting >24 hours) High parity Use of certain medications:Magnesium sulfateProlonged use of oxytocin during laborInhaled anesthesia (ie, general anesthesia) Educational objective:Postpartum hemorrhage is defined as maternal blood loss of >500 mL after a vaginal birth or >1000 mL after a cesarean birth. Uterine atony (ie, "boggy" uterus) is the most common cause of early postpartum hemorrhage (occurring ≤24 hours after birth). Risk factors include uterine distension, uterine fatigue, high parity, and certain medications.

The nurse is caring for a postpartum client 36 hours after a cesarean birth who was just diagnosed with postpartum endometritis. Which prescription is priority for the nurse to administer? Click the exhibit button for additional information. 1. Acetaminophen PO PRN for fever 2. Clindamycin IV every 8 hours 3. Lactated Ringer IV bolus once 4. Methylergonovine PO every 4 hours

2. Clindamycin IV every 8 hours Postpartum endometritis occurs when the endometrium (uterine lining) becomes infected after birth, often beginning at the placental site. Endometritis is characterized by uterine tenderness and subinvolution, foul-smelling or purulent lochia, fever, tachycardia, and chills. Cesarean birth is a primary risk factor, particularly if performed emergently or after prolonged labor. The infection is usually polymicrobial and requires treatment with broad-spectrum antibiotics (eg, IV clindamycin plus IV gentamicin). Antibiotic administration is a priority because it treats the primary cause of endometritis and prevents complications related to the spread of infection (eg, abscess, peritonitis) (Option 2). Antibiotics are required until approximately 24 hours after symptoms resolve. Educational objective:Postpartum endometritis is an infection of the endometrium (uterine lining) and is characterized by fever, chills, tachycardia, uterine tenderness, and foul-smelling or purulent lochia. The nurse's priority intervention is initiation of broad-spectrum antibiotics to treat the infection and reduce the risk of complications (eg, abscess, peritonitis). Subsequent interventions include antipyretics, IV fluids, and (possibly) uterotonics for uterine subinvolution.

The nurse is performing a postpartum assessment 12 hours after the prolonged vaginal delivery of a term infant. Which assessment findings should be reported to the health care provider? 1. Complaints of discomfort during fundal palpation 2. Foul-smelling lochia 3. Oral temperature 100.1 F (37.8 C) 4. White blood cell (WBC) count 24,000/mm3 (24.0 x 109/L)

2. Foul-smelling lochia A foul odor of lochia suggests endometrial infection. This client has an increased risk of infection due to her prolonged labor, which involved multiple cervical examinations. The odor of lochia is usually described as "fleshy" or "musty." A foul smell warrants further evaluation. Other signs of endometrial infection are maternal fever, tachycardia, and uterine pain/tenderness. Educational objective: Signs of endometrial infection include elevated temperature, chills, malaise, excessive pain, and foul-smelling lochia. During the first 24 hours postpartum, temperature and WBC count are normally elevated. Fever and leukocyte counts that do not decrease require further evalua

A client is admitted to the postpartum floor after a vaginal birth. Which finding indicates the need for immediate intervention? 1. Lochia that soaks a perineal pad every 2 hours 2. Persistent headache with blurred vision 3. Red, painful nipple on one breast 4. Strong-smelling vaginal discharge

2. Persistent headache with blurred vision Persistent headache and blurred vision could indicate postpartum preeclampsia. The majority of clients with preeclampsia develop symptoms before birth; however, a small percentage do not develop the complication until several days after birth. This potentially serious condition can rapidly worsen, leading to seizures and death if left untreated. Additional signs and symptoms may include high blood pressure, proteinuria, and edema (Option 2). Educational objective: Preeclampsia can develop in the postpartum period several days after birth. Clients in the postpartum period with signs and symptoms of preeclampsia (eg, edema, persistent headache, vision changes, elevated blood pressure) should be evaluated and treated immediately.

Prior to hospital discharge, the nurse discusses sexuality after childbirth with a client who had an uncomplicated vaginal birth with no perineal lacerations. Which client statement requires further teaching? 1. "I should avoid resuming sexual intercourse until after my vaginal bleeding has stopped." 2. "I should expect vaginal dryness and use water-soluble lubricants, especially if I'm breastfeeding." 3. "I will begin using condoms to prevent pregnancy once menses returns." 4. "I will try to feed my baby before my partner and I engage in sexual activity."

3. "I will begin using condoms to prevent pregnancy once menses returns." Initiating an open discussion about sexual activity after childbirth allows the nurse to provide anticipatory guidance and recognize individual client concerns (eg, discomfort, fatigue, fear, body image). The nurse should plan to reinforce the use of contraception because many clients resume sexual activity before their postpartum checkup (4-6 weeks after birth), when contraception methods are usually prescribed. Ovulation may occur as early as 4 weeks after birth and before resumption of menses, especially in clients who formula feed. Clients should be encouraged to use a barrier contraceptive such as condoms to prevent pregnancy until another form of birth control can be prescribed (Option 3). Educational objective:Many postpartum clients resume sexual activity before their postpartum checkups (4-6 weeks after birth). Encouraging the use of barrier contraceptives (eg, condoms) to prevent pregnancy is important because ovulation may occur as early as 4 weeks after birth and before resumption of menses.

The nurse is teaching a postpartum client about breastfeeding. Which statement by the client indicates a correct understanding of teaching? 1. "I will feed my baby for 5-10 minutes on each breast." 2. "I will hold my baby on their back with the head turned toward my breast." 3. "If I need to reposition my baby's latch, I will use my finger to break the suction first." 4. "The baby's mouth should grasp only the nipple without the areola."

3. "If I need to reposition my baby's latch, I will use my finger to break the suction first." Sore nipples and painful breastfeeding are common reasons clients discontinue breastfeeding. Teaching proper technique helps clients continue breastfeeding, promotes comfort for the mother, and ensures adequate newborn nutrition. Key principles of proper breastfeeding and latch technique include: Breastfeed every 2-3 hours on average (8-12 times/day) Breastfeed "on demand" whenever the newborn exhibits hunger cues (eg, sucking, rooting reflex) Position the newborn "tummy to tummy" with mouth in front of nipple and head in alignment with body Ensure a proper latch (ie, grasps both nipple and part of areola) Feed for at least 15-20 minutes per breast or until the newborn appears satisfied Insert a clean finger beside the newborn's gums to break suction before unlatching (Option 3) Alternate which breast is offered first at each feeding Educational objective:If the newborn latches incorrectly or needs to be removed from the breast, the client should insert a finger to break suction before unlatching. When the newborn is removed from the breast incorrectly, nipple trauma may occur, leading to sore nipples and painful breastfeeding.

The graduate nurse (GN) receives report on a postpartum client with an Rh-negative blood type. Which statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide further teaching? 1. "Additional doses of Rh immune globulin may be required if excessive fetomaternal hemorrhage is suspected." 2. "I should administer Rh immune globulin to the client within 72 hours after birth." 3. "If the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health care provider." 4. "Rh immune globulin is not required if the newborn's blood type is Rh negative."

3. "If the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health care provider." Rh alloimmunization (ie, isoimmunization) occurs when a pregnant client with an Rh-negative blood type is exposed to Rh-positive fetal RBCs during pregnancy and birth. After exposure, the maternal immune system produces antibodies to the Rh antigen that can cause serious complications for an Rh-positive fetus during future pregnancies (eg, hemolytic anemia). Rh immune globulin (RhoGAM) prevents antibody formation by suppressing the maternal immune response and is effective only if the client has never developed antibodies to the Rh antigen (ie, Rh sensitization). The nurse should verify that the client is not Rh sensitized by checking for a negative antibody screen (eg, indirect Coombs test) and then proceeding with administration of Rh immune globulin (Option 3). A positive maternal antibody screen would require further clarification from the health care provider (HCP). Educational objective:Rh alloimmunization occurs when a pregnant client with an Rh-negative blood type is exposed to Rh-positive fetal RBCs. Postpartum, the nurse should verify that the client is not Rh sensitized by checking for a negative antibody screen and then proceeding with administration of Rh immune globulin if the newborn is Rh positive.

A nurse is providing care to a group of postpartum clients. Which client comment should prompt further investigation? 1. "I feel so exhausted that I started taking naps when the baby sleeps." 2. "I have trouble sleeping well at night because I worry that I won't hear the baby cry." 3. "My aunt has come over every day to care for the baby because the baby's cries bother me." 4. "My spouse thinks that I have been more emotional since I had the baby last week."

3. "My aunt has come over every day to care for the baby because the baby's cries bother me."

The nurse provides a follow-up phone call to a client who gave birth at a birthing center 5 days ago. Which statement by the client should the nurse be most concerned about? 1. "I am really tired all of the time since giving birth." 2. "I saw some bright red blood in my bowel movement yesterday." 3. "My bleeding is like a really heavy period with some blood clots." 4. "My hands feel tingly when I hold the baby for a long time."

3. "My bleeding is like a really heavy period with some blood clots." Postpartum hemorrhage (PPH) may be primary (ie, <24 hours since birth) or secondary/delayed (ie, >24 hours but <6 weeks postpartum). Secondary PPH usually results from uterine subinvolution, retained placental fragments/membranes, or uterine infection. The nurse should expect a client >3-4 days postpartum to report a progressive change in lochia from lochia rubra (dark-red vaginal bleeding) to lochia serosa (pink or brown discharge). A gradual decrease in the amount of lochia is reassuring and expected. However, reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots (ie, larger than a nickel) are concerning findings that require the nurse's immediate follow-up (Option 3). Educational objective:Secondary or delayed postpartum hemorrhage (PPH) occurs >24 hours but <6 weeks postpartum. Reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots are concerning findings associated with secondary PPH.

The postpartum nurse is assessing a client who gave birth by cesarean section 5 hours ago and is requesting pain medication. The client appears restless, has a heart rate of 110/min, and admits to recent onset of anxiety. What priority action should the nurse take? 1. Assess for lower extremity warmth and redness 2. Instruct the client in relaxation breathing techniques 3. Obtain oxygen saturation reading by pulse oximeter 4. Offer the client prescribed PRN pain medication

3. Obtain oxygen saturation reading by pulse oximeter Pregnancy is a hypercoagulable state that provides protection from hemorrhage after birth, but also greatly augments risk of thrombus formation. Women who give birth by cesarean section are at particularly increased risk for deep venous thrombosis (DVT). Additional risk factors for DVT include obesity, smoking, and genetic predisposition. If unrecognized, DVT may progress to pulmonary embolism (PE), often characterized by anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, and hemoptysis. The nurse's priority is rapidly identifying symptoms, assessing respiratory status, administering supplemental oxygen, and notifying the health care provider (HCP) Educational objective:Pregnancy is a hypercoagulable state that increases risk for deep venous thrombosis and pulmonary embolism (PE). Signs and symptoms of PE include anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, and hemoptysis. Priorities are rapid symptom identification, assessment of oxygenation, and notification of the health care provider.

A client who gave birth vaginally with epidural anesthesia still has limited movement and strength of the right leg, and reports no urge to urinate at 2 hours postpartum. The nurse palpates the client's fundus 2 cm above the umbilicus and to the right. What should the nurse do next? 1. Assist the client to the bathroom in a wheelchair 2. Encourage the client to drink plenty of fluids 3. Perform in-and-out catheterization 4. Reassess for bladder distension hourly

3. Perform in-and-out catheterization Postpartum urinary retention is commonly related to decreased bladder sensation (eg, due to regional anesthesia, prolonged labor, or perineal trauma) and postpartum diuresis. Urinary retention can cause bladder distension, which may be noted by a displaced and/or boggy uterus, or by a palpable bladder. If bladder distension cannot be resolved with spontaneous voiding, in-and-out (I&O) catheterization may be indicated, especially if the client: Is unable to ambulate to the restroom or void into a bedpan (Option 3) Has not voided within 6-8 hours after delivery or removal of the indwelling urinary catheter after cesarean delivery Has difficulty emptying bladder completely (ie, voiding <100 mL frequently) Educational objective:Signs of bladder distension in a postpartum client include a displaced and/or boggy uterus, or a palpable bladder. Performing an in-and-out catheterization can help prevent postpartum hemorrhage related to uterine atony and injuries related to falls if sensory/motor function of the lower extremities is decreased.

The pediatric nurse is performing an assessment on a 4-week-old client in the clinic. During the assessment, the newborn's mother starts to cry and states, "I am the worst mother in the world." What should the nurse ask next? 1. "Do you have a support system to help process your feelings?" 2. "Do you have any questions about how to care for your newborn?" 3. "Have you experienced difficulty falling asleep or getting rest?" 4. "Have you felt depressed or hopeless over the last 2 weeks?"

4. "Have you felt depressed or hopeless over the last 2 weeks?" Postpartum depression (PPD) is a perinatal mood disorder that affects women following childbirth. Symptoms may include crying, irritability, difficulty sleeping (or sleeping more than usual), anxiety, and feelings of guilt. Symptoms typically arise within 4 weeks of delivery and can affect the mother's ability to care for herself and the newborn. The nurse should ask specific questions about depression or hopelessness to assess for PPD (Option 4). It is also important to ask about thoughts of self-harm or harm to the newborn. Educational objective:Postpartum depression (PPD) is a perinatal mood disorder characterized by crying, irritability, sleep disturbances, anxiety, or feelings of guilt. Nurses should assess for PPD by asking specific questions about feelings of depression and hopelessness as well as thoughts about self-harm or harm to the newborn.

The nurse receives report on several postpartum clients who gave birth at term gestation. Which client should the nurse assess first? 1. Client, G1, P1, who is 24 hours postcesarean birth with cramping and foul-smelling lochia. 2. Client, G1, P1, who is 72 hours postvaginal birth, on bed rest, and taking enoxaparin for a deep venous thrombosis. 3. Client, G4, P3, who is 72 hours postcesarean birth with a temperature of 100.8 F (38.2 C) and a red, swollen breast 4. Client, G5, P5, who is 12 hours postvaginal birth and saturating perineal pads every hour for 2 hours with lochia rubra

4. Client, G5, P5, who is 12 hours postvaginal birth and saturating perineal pads every hour for 2 hours with lochia rubra Postpartum hemorrhage can occur immediately after birth of the placenta or in the hours and days following birth. Risk factors include grand multiparity (ie, ≥5 births), intrauterine infection, prolonged labor, use of oxytocin during labor, and coagulopathy. A perineal pad that is saturated in ≤1 hour indicates heavy/excessive bleeding, which may lead to hemodynamic compromise if not recognized and corrected with interventions (eg, fundal massage, uterotonics). A client with a high parity who saturated a pad every hour for the past two hours is experiencing excessive bleeding, potentially due to uterine atony. The nurse should immediately assess the client's fundal tone, lochia amount, and vital signs and notify the health care provider (Option 4). Educational objective:The nurse should prioritize assessment of clients with signs of immediately life-threatening postpartum complications (eg, hemorrhage, pulmonary embolism). A perineal pad that is saturated in ≤1 hour indicates excessive bleeding and requires immediate assessment to prevent hemodynamic compromise.

A nurse is caring for a postpartum client who has chosen to exclusively formula feed her newborn for medical reasons and is experiencing breast engorgement. What should the nurse teach regarding relief of breast engorgement? 1. Apply heat frequently to both breasts for 15-20 minutes 2. Manually express milk several times a day 3. Massage breasts from the base to the nipple 3 or 4 times a day 4. Use chilled, fresh cabbage leaves on breasts throughout the day

4. Use chilled, fresh cabbage leaves on breasts throughout the day Breast engorgement is often painful. The management of engorgement varies based on the client's breastfeeding status; for clients who choose not to breastfeed, treatment focuses on managing symptoms while promoting reduced milk production. Comfort measures include: Applying ice packs to both breasts for 15-20 minutes every 3-4 hours to reduce blood flow and swelling Applying chilled, fresh cabbage leaves to both breasts, replacing with fresh leaves after they wilt. The mechanism of action is unclear but may be related to the cool temperature or to phytoestrogens from the leaves (Option 4). Taking an anti-inflammatory analgesic (eg, ibuprofen) as directed to reduce pain Maintaining firm breast support (eg, supportive bra, breast binder) until milk flow is diminished Educational objective:Stimulation of milk production (eg, manual milk expression, breast massage) is avoided in clients who intend to exclusively formula feed. Comfort measures for breast engorgement include application of ice packs and chilled, fresh cabbage leaves; analgesics; and firm breast support.