A nurse is caring for a 28-year-old postpartum female client in the postpartum unit.
Medical History:
The client is on postpartum day 1. She is breastfeeding her newborn every 4 to 5 hours for 30 to 40 minutes each time. She reports some nipple discomfort during the feedings. The nurse assisted the client with positioning and latch and recommended the client awaken the newborn to feed every 3 hours during the day. The newborn voided twice and passed two meconium stools in the past 24 hours.
Vital Signs:
Blood Pressure: 120/80 mmHg
Pulse: 80 bpm
Respirations: 16/min
Temperature: 36.8°C (98.2°F)
Pulse Ox: 99%
Nurses Notes: On postpartum day 2, the client reports breastfeeding every 3 to 4 hours and experiencing nipple discomfort during some feedings. No physical findings of nipple trauma are noted, and the breasts are soft. The client denies feelings of fullness. The newborn voided twice and passed three meconium stools in the second 24 hours of life. Discharge teaching was provided to the client regarding breastfeeding.
Querry: Which of the following statements by the client indicates an understanding of the discharge teaching? Click to highlight the client statements that indicate an understanding of the discharge teaching.
"Because of my baby's weight loss, I need to supplement with formula after breastfeeding."
"I should make sure that my baby feeds 8 to 12 times per day, and on demand."
"I should cover my sore nipples with plastic-lined breast pads after every feeding."
"My baby's stools should turn from the dark greenish color meconium to a yellow color within the next day or two."
I can increase my milk supply by drinking more whole milk.
I should expect my breasts to feel full, warm, and slightly tender when my milk comes in.
Correct Answer : B,D,F
Choice A rationale:
Supplementing with formula is not necessary based on the given information. The baby is voiding and passing stools adequately, indicating proper feeding. Instead, feeding on demand and ensuring frequent breastfeeding will help address any concerns about the baby's weight.
Choice B rationale:
Feeding 8 to 12 times per day and on demand is recommended to ensure adequate milk supply and proper growth and development of the newborn. Frequent feeding helps to establish and maintain milk production.
Choice C rationale:
Using plastic-lined breast pads is not recommended as they can trap moisture and create an environment that promotes nipple irritation and infection. It is better to use breathable, non-plastic-lined breast pads.
Choice D rationale:
It is correct that a newborn's stools should transition from the dark greenish color meconium to a yellow color within a few days as the baby begins digesting breast milk.
Choice E rationale:
Drinking more whole milk does not directly increase a mother's milk supply. Milk supply is primarily regulated by the frequency and efficiency of breastfeeding or pumping.
Choice F rationale:
Expecting the breasts to feel full, warm, and slightly tender when the milk comes in is accurate. This usually occurs around the third or fourth day postpartum and indicates that the milk production process is underway.
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Correct Answer is ["A","B","C","D","G"]
Explanation
Choice A: Respiratory assessment
The newborn is exhibiting signs of respiratory distress, such as mild grunting, nasal flaring, and intermittent retractions. These symptoms indicate potential respiratory issues that need immediate attention.
Choice B: Hemoglobin
The newborn's hemoglobin level is 9 g/dL, which is below the normal range of 14 to 24 g/dL2. This indicates anemia, which can affect the baby's oxygen-carrying capacity and overall health.
Choice C: Serum glucose
The newborn's serum glucose level is 38 mg/dL, which is below the normal range of 40 to 45 mg/dL2. Hypoglycemia in newborns can lead to serious complications if not addressed promptly.
Choice D: Heart rate
The newborn's heart rate is 180 beats per minute, which is above the normal range for a newborn (normal range: 120-160 beats per minute)2. This tachycardia could be a response to stress or an underlying condition that needs evaluation.
Choice G: Hematocrit
The newborn's hematocrit level is 35%, which is below the normal range of 44% to 64%2. This further supports the presence of anemia and the need for intervention2
Correct Answer is A
Explanation
Choice A rationale
Methylergonovine (Methergine) is contraindicated in clients with hypertension because it can cause severe hypertension by increasing vascular resistance, leading to potential complications such as stroke.
Choice B rationale
Oxytocin (Pitocin) is used to induce labor and control postpartum hemorrhage and does not significantly increase blood pressure, making it safe for use in hypertensive patients.
Choice C rationale
Carboprost (Hemabate) is used to control severe postpartum hemorrhage and does not have significant effects on blood pressure. It is generally safe for hypertensive patients.
Choice D rationale
Misoprostol (Cytotec) is used for postpartum hemorrhage management and does not significantly affect blood pressure, making it safe for hypertensive patients.