A nurse in a clinic is teaching the mother of a 4-month-old infant who has been breastfed. The mother plans to switch her infant to an iron-fortified formula. Which of the following should be included in the teaching?

Choice a reason:
Elevated blood pressure is a primary indicator for preeclampsia, which is a condition characterized by hypertension and often proteinuria after 20 weeks of gestation. The criteria for hypertension in pregnancy are a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher on two occasions at least 4 hours apart. If a pregnant client presents with elevated blood pressure, it is crucial for the nurse to initiate further evaluation for preeclampsia, as this condition can lead to serious complications for both the mother and the fetus.

Choice b reason:
Joint pain is not a typical sign of preeclampsia. While joint pain can be a symptom experienced during pregnancy due to various physiological changes, it is not specifically associated with preeclampsia and does not warrant further evaluation for this disorder on its own.

Choice c reason:
Vaginal discharge during pregnancy is common and can vary in consistency and amount. It is not a specific indicator of preeclampsia unless accompanied by other symptoms such as elevated blood pressure or proteinuria. Normal vaginal discharge is usually clear or milky white and does not indicate the need for preeclampsia evaluation.

Choice d reason:
Increased urine output is not typically associated with preeclampsia. In fact, preeclampsia can sometimes lead to reduced urine output due to kidney impairment. If a client has increased urine output, it may be due to other factors such as increased fluid intake or gestational diabetes.

Choice a reason:
Panting can help control the urge to push and is often recommended during the crowning stage to prevent tearing and to allow the perineum to stretch gradually. It can also help manage the pain and provide the baby with a gentle descent.

Choice b reason:
Slow-paced breathing is generally advised during the earlier stages of labor to help manage contractions and maintain relaxation. However, during the crowning stage, slow-paced breathing might not be effective in controlling the strong urge to push.

Choice c reason:
Telling the client to go ahead and push without proper guidance could lead to rapid delivery, which increases the risk of perineal tearing. The nurse should instruct the client on when and how to push effectively, often during a contraction, with controlled effort.

Choice d reason:
Taking a deep, cleansing breath can be calming and help the client focus, but it does not directly address the immediate need to control the pushing during crowning. Controlled breathing techniques specific to the delivery stage are more appropriate.