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?

Choice A rationale: Transient hypoglycemia is a common physiologic occurrence in term newborns during the first few hours after birth due to the abrupt cessation of maternal glucose supply. The newborn must transition to endogenous glucose production through glycogenolysis and gluconeogenesis. This transitional dip typically resolves with feeding and thermoregulation, making this statement scientifically accurate and reflective of normal neonatal adaptation.

Choice B rationale: Skin-to-skin contact enhances thermoregulation by reducing heat loss through conduction and evaporation. Maintaining a stable body temperature reduces metabolic demands and conserves glucose stores. Additionally, skin-to-skin contact promotes early breastfeeding, which provides exogenous glucose. These combined effects help stabilize neonatal blood glucose levels, making this an evidence-based intervention for hypoglycemia prevention and management.

Choice C rationale: Clamping the umbilical cord terminates the placental transfer of maternal glucose, which is the fetus’s primary energy source in utero. After birth, the newborn must rely on hepatic glycogen stores and initiate gluconeogenesis to maintain glucose homeostasis. This sudden metabolic shift can lead to transient hypoglycemia, especially in infants with increased glucose demands or limited glycogen reserves.

Choice D rationale: Persistent hypoglycemia, particularly glucose levels consistently below 50 mg/dL despite adequate feeding, may necessitate intravenous glucose administration to prevent neurologic injury. IV dextrose provides immediate correction of hypoglycemia when oral intake is insufficient or symptoms are severe. This intervention is especially critical in symptomatic infants or those at high risk, such as macrosomic newborns or infants of diabetic mothers.

Choice E rationale: The lower limit of normal blood glucose in neonates is generally considered to be 40 mg/dL in the first 4 hours and 45 mg/dL after that. However, stating that 40 to 45 mg/dL is the normal lower limit for up to 72 hours is imprecise. Glucose thresholds vary slightly by institution and age in hours, and levels should ideally rise above 50 mg/dL with feeding. Therefore, this statement lacks full accuracy.

Choice F rationale: Frequent breastfeeding provides a consistent source of glucose and stimulates endogenous insulin regulation. Early and effective feeding is the primary intervention for asymptomatic hypoglycemia in term infants. Breast milk contains lactose, which is metabolized into glucose and galactose, supporting energy needs. Therefore, this statement correctly reflects the role of frequent feeding in stabilizing neonatal glucose levels.

✅ Anticipated Orders – Rationales

• Initiate morphine per protocol Morphine is commonly used to manage moderate to severe symptoms of NAS. It helps reduce central nervous system irritability and autonomic overactivity by binding to opioid receptors, thereby easing withdrawal symptoms.
• Encourage breastfeeding Breastfeeding is encouraged unless contraindicated (e.g., maternal HIV or ongoing illicit drug use). Breast milk may contain small amounts of opioids if the mother is on medication-assisted treatment (e.g., methadone or buprenorphine), which can help ease withdrawal symptoms in the newborn.
• Offer small, frequent feedings Infants with NAS often have poor feeding due to uncoordinated suck and gastrointestinal symptoms. Small, frequent feedings help maintain adequate nutrition and prevent hypoglycemia.
• Consult social services Given the maternal history of opioid use disorder and lack of stable housing, social services involvement is essential for discharge planning, ensuring a safe environment, and connecting the family with community resources.
• Monitor using the eat, sleep, console scoring tool This tool is a functional assessment method used to evaluate NAS severity and guide treatment. It focuses on the infant’s ability to eat, sleep, and be consoled rather than just symptom counting.

❌ Not Anticipated Order – Rationale

• Administer naloxone Naloxone is contraindicated in neonates with NAS because it can precipitate acute, severe withdrawal. It is only used in cases of life-threatening opioid overdose, not for withdrawal management.