A breastfeeding woman develops engorged breasts at 3 days postpartum.
What action would help this woman achieve her goal of reducing the engorgement?

Choice A rationale

Absent early decelerations of the fetal heart rate are generally considered a reassuring sign. Early decelerations are a gradual decrease and return of the fetal heart rate associated with uterine contractions, thought to be caused by fetal head compression. Their absence does not typically warrant immediate reporting.

Choice B rationale

A fetal heart rate of 140 beats per minute falls within the normal range for a term fetus, which is typically between 110 and 160 beats per minute. This finding is reassuring and does not require immediate reporting to the provider.

Choice C rationale

Contraction frequency of 2 to 3 minutes apart indicates that the labor is progressing. While the overall pattern of contractions needs to be evaluated in conjunction with other factors like duration and intensity, a frequency within this range is not necessarily a concerning finding that requires immediate reporting on its own.

Choice D rationale

Contraction durations of 95 to 100 seconds are considered prolonged. Normal contraction duration in the active phase of labor typically ranges from 45 to 60 seconds. Prolonged contractions can reduce uterine blood flow and potentially lead to fetal hypoxia, making this a concerning finding that should be promptly reported to the provider for further evaluation.

Choice A rationale

Positioning the newborn supine on a radiant warmer is appropriate for maintaining thermoregulation. However, applying only a sterile gauze dressing to a large abdominal wall defect that is not covered by a membrane does not adequately protect the exposed organs from contamination, drying, or injury. This increases the risk of infection and fluid loss.

Choice B rationale

Placing the newborn into a sterile bowel bag up to the axilla is the recommended immediate action for an abdominal wall defect such as gastroschisis (protrusion without a membrane). The sterile bag helps to maintain a moist environment, prevent heat and fluid loss, and protect the exposed organs from trauma and contamination until surgical repair can be performed.

Choice C rationale

While breastfeeding promotes bonding and provides essential nutrients, it is not the priority action for a newborn with a large, uncovered abdominal wall defect immediately after birth. The immediate focus should be on protecting the exposed organs and stabilizing the newborn. Breastfeeding can be initiated once the newborn is stable and the abdominal defect is appropriately managed.

Choice D rationale

Providing intermittent suction via an orogastric tube may be necessary later to decompress the gastrointestinal system, but it is not the immediate priority for a newborn with a large, uncovered abdominal wall defect. The initial action should focus on protecting the exposed organs.