A nurse is interviewing the partner of a client who was admitted in the manic phase of bipolar disorder. The partner states, "I don't know what to do. Everything has been happening so quickly." Which of the following responses by the nurse is therapeutic?

Rationale for correct choices

• Intrauterine growth restriction: The client has experienced persistent nausea and vomiting, reduced oral intake, and a 1.8 kg (4 lb) weight loss over 5 weeks. These factors contribute to maternal malnutrition, which can limit fetal growth and development. Early identification of inadequate maternal nutrition is critical to prevent complications such as low birth weight, preterm birth, and impaired fetal organ development.

• Thiamine deficiency: Prolonged vomiting and poor nutritional intake increase the risk of vitamin deficiencies, particularly thiamine (vitamin B1). Thiamine deficiency in pregnancy can lead to Wernicke’s encephalopathy, neurological complications, and exacerbate maternal fatigue. Prompt recognition and supplementation are essential for both maternal and fetal health.

Rationale for incorrect choices

• Hypernatremia: While dehydration may accompany vomiting, severe vomiting usually leads to hyponatremia and hypokalemia (electrolyte loss) along with metabolic alkalosis. Hypernatremia is less likely than other complications in this scenario, as the client’s main concern is inadequate intake rather than excessive sodium loss.

• Amniotic fluid embolism: Amniotic fluid embolism is an acute, rare obstetric emergency that typically occurs during labor or immediately postpartum. The client’s current presentation in the first trimester does not indicate risk for this condition.

• Chorioamnionitis: Chorioamnionitis is an intrauterine infection usually associated with membrane rupture and labor. There is no report of infection, fever, or membrane compromise in this client. It is not an immediate risk at this stage of pregnancy.

A. "This test should be performed after your baby is 24 hours old.": Newborn genetic screening is ideally performed after 24 hours of life to ensure accurate detection of metabolic and endocrine disorders. Performing the test too early can result in false-negative results due to insufficient accumulation of metabolites in the blood.

B. "A nurse will draw blood from your baby's inner elbow.": Newborn screening is typically performed via a heel stick, not from the inner elbow. The lateral or plantar aspect of the heel provides safe access to capillary blood for accurate testing.

C. "Your baby will be given 2 ounces of water to drink prior to the test.": Newborns are not given water prior to screening. Water administration is unnecessary and could be harmful, as infants should receive breast milk or formula to meet hydration needs.

D. "This test will be repeated when your baby is 2 months old.": While some repeat testing may occur if initial results are inconclusive, routine newborn genetic screening is performed once after 24 hours of life, not automatically repeated at 2 months.