A nurse is planning care for a newborn who has spinal bifida. Which of the following actions should be included in the plan of care?

Correct Choices for Indicating Understanding:

• "I should make sure that my baby feeds 8 to 12 times per day."
• "My baby's stools should turn to a yellow color within the next day or two."
• "I should expect my breasts to become harder, warmer, and more tender when my milk comes in."

Rationale

• "Because of my baby's weight loss, I need to supplement with formula after breastfeeding."

  • This statement does not necessarily indicate an understanding of discharge teaching, as supplementation should only be done based on medical advice and not solely based on perceived weight loss.

• "I should make sure that my baby feeds 8 to 12 times per day."

  • This statement indicates an understanding of discharge teaching, as frequent feeding is important for newborns to ensure adequate nutrition and hydration, and to promote milk production in breastfeeding mothers.

• "I should cover my sore nipples with plastic-lined breast pads after every feeding."

  • This statement does not indicate proper understanding, as plastic-lined breast pads can retain moisture and increase the risk of infection. Instead, breathable pads or natural remedies are often recommended.

• "My baby's stools should turn to a yellow color within the next day or two."

  • This statement indicates an understanding of normal neonatal stool changes, as breastfed babies' stools typically transition to a yellow color within a few days of birth.

• "I can increase my milk supply by drinking more water."

  • While staying hydrated is important, this statement alone is insufficient for indicating a comprehensive understanding of increasing milk supply. Effective breastfeeding practices and frequent nursing are more directly impactful.

• "I should expect my breasts to become harder, warmer, and more tender when my milk comes in."

  • This statement indicates an understanding of the common experience of breast engorgement when milk comes in, which is a normal part of the breastfeeding process.

Late decelerations on the fetal monitor tracing indicate uteroplacental insufficiency, which can compromise fetal oxygenation. When membranes rupture and late decelerations occur, it's essential to take immediate action to improve fetal oxygenation.
Turning the client onto her side can help improve uteroplacental perfusion by relieving pressure on the vena cava and increasing blood flow to the uterus. This is the initial recommended intervention to optimize fetal oxygenation in the presence of late decelerations.
B. Increasing IV fluid infusion rate may be considered to optimize maternal hydration and potentially improve uteroplacental perfusion. However, it may not be the first action taken in response to late decelerations.
C. Palpating the client's uterus can provide information about uterine activity and may help assess for uterine hyperstimulation, which can contribute to fetal distress. However, in the context of late decelerations, the priority is to address potential uteroplacental insufficiency and optimize fetal oxygenation.
D. Administering oxygen to the client helps increase maternal oxygenation, which in turn improves fetal oxygenation. Oxygen administration is done after positing the client on to the lateral position.