A nurse is providing discharge teaching to a new parent about breastfeeding her infant. Which of the following statements should the nurse make?

Rationale for Correct Choices

• Administer oxygen at 2 L/min via nasal cannula: The client’s oxygen saturation of 92% indicates mild hypoxemia, which can worsen myocardial ischemia. Administering low-flow oxygen enhances myocardial oxygen delivery and helps reduce chest pain and tissue damage.

• Administer sublingual nitroglycerin: After oxygen therapy, sublingual nitroglycerin is the next appropriate step to relieve ischemic chest pain. It dilates coronary arteries, improves blood flow, and reduces myocardial oxygen demand. The nurse should monitor blood pressure and pain relief closely after administration.

Rationale for Incorrect Choices

• Request a prescription for an increase in statin medication: Although the client’s total cholesterol and LDL levels are elevated, statin adjustment is a long-term management measure. It does not address the acute chest pain or compromised oxygenation that the client is currently experiencing.

• Prepare the client for cardiac catheterization: While cardiac catheterization may be needed if myocardial infarction is confirmed, immediate stabilization of oxygen and pain takes priority. The nurse must first implement emergency interventions before preparing for invasive procedures.

• Request a prescription for a beta-blocker: Beta-blockers help lower heart rate and myocardial oxygen demand but are not administered during initial emergency management. They are prescribed only after the client is stabilized and contraindications have been ruled out.

• Checking a STAT cardiac troponin: Checking a STAT cardiac troponin is an important diagnostic action to rule in or out an acute myocardial infarction, however, clinical management of acute symptoms takes precedence over waiting for a laboratory result.

Rationale:
A. Hypothermia: Hypothermia increases metabolic demand and glucose utilization in newborns, making them more susceptible to hypoglycemia. Maintaining normal body temperature is crucial for preventing low blood glucose levels.

B. Maternal diabetes: Infants born to mothers with diabetes are at higher risk for hypoglycemia due to fetal hyperinsulinemia. After birth, the excess insulin can cause rapid drops in blood glucose.

C. Anemia: While anemia affects oxygen-carrying capacity, it is not a direct risk factor for neonatal hypoglycemia. Blood glucose regulation is not primarily impacted by red blood cell count.

D. Prematurity: Premature infants have limited glycogen stores and immature glucose regulation, increasing the risk for hypoglycemia. They may require closer glucose monitoring and early feeding interventions.

E. Thrombocytopenia: Low platelet count does not affect glucose metabolism and is not a recognized risk factor for neonatal hypoglycemia.