A nurse is reinforcing discharge instructions with a postpartum client about breastfeeding.
Which of the following statements by the client indicates an understanding of the teaching?

? Rationale for Correct Answers

Diabetic diet is appropriate because the client meets diagnostic criteria for gestational diabetes mellitus (GDM). The 3-hour oral glucose tolerance test (OGTT) shows two or more elevated values:

• 1-hour: 220 mg/dL (normal <180 mg/dL)
• 2-hour: 165 mg/dL (normal <140 mg/dL)
• 3-hour: 142 mg/dL (normal 70–115 mg/dL)

According to the American Diabetes Association and ACOG, GDM is diagnosed when at least two values exceed thresholds. GDM increases risks for macrosomia, preeclampsia, and neonatal hypoglycemia, and requires dietary management as first-line therapy.

30 cal/kg/day is the recommended caloric intake for overweight or obese pregnant individuals with GDM. Caloric needs are based on pre-pregnancy weight:

• Normal BMI: 30–35 kcal/kg/day
• Overweight (BMI 25–29.9): 25 kcal/kg/day
• Obese (BMI ≥30): 30 kcal/kg/day is often used to balance fetal growth and glycemic control.

❌ Rationale for Incorrect Response 1 Options

Low-sodium diet is used for hypertension or preeclampsia, but this client has no signs of preeclampsia (e.g., proteinuria, headache, visual changes, epigastric pain).

High-protein diet is not a standard intervention for GDM and may worsen insulin resistance if not balanced.

Gluten-free diet is indicated for celiac disease, which is not present here.

❌ Rationale for Incorrect Response 2 Options

15–25 cal/kg/day are too low for pregnancy and may risk fetal growth restriction, especially in obese clients.

20 cal/kg/day is used in severe obesity or when caloric restriction is medically necessary, but not standard for GDM.

25 cal/kg/day is more appropriate for overweight (not obese) clients.

? Take-Home Points

• GDM is diagnosed with ≥2 abnormal values on a 3-hour OGTT.
• Dietary therapy is first-line management for GDM, focusing on controlled carbohydrate intake.
• Obese pregnant clients with GDM should receive ~30 kcal/kg/day based on pre-pregnancy weight.
• GDM increases risks for maternal and fetal complications and requires close monitoring.

Choice A rationale

Applying witch hazel compresses (often in the form of Tucks pads) is an effective and common intervention for episiotomy discomfort. Witch hazel possesses astringent and anti-inflammatory properties that can reduce swelling, soothe irritation, and promote healing of the perineal tissues, providing significant pain relief for the postpartum client.

Choice B rationale

Administering aspirin is generally contraindicated in the immediate postpartum period, especially if there is any risk of bleeding or if the client is breastfeeding. Aspirin can inhibit platelet aggregation, increasing the risk of postpartum hemorrhage. Safer analgesics, such as NSAIDs like ibuprofen, or acetaminophen, are preferred for pain relief.

Choice C rationale

Having the client use a warm pack is generally not recommended for immediate episiotomy discomfort. While warmth can be soothing, a warm pack can increase blood flow to the area, potentially increasing swelling and discomfort or exacerbating any bleeding in the immediate postpartum period. Cold applications are typically preferred initially.

Choice D rationale

Instructing the client to sit on a soft pillow may provide some comfort by distributing pressure, but it does not directly address the underlying pain and inflammation from the episiotomy. While it can be a supportive measure, it is not as therapeutically effective as direct interventions like cold packs, witch hazel, or appropriate analgesia. .