A nurse is reinforcing teaching with a client about the use of a transcutaneous electrical nerve stimulation (TENS) device for back pain during labor.
Which of the following information should the nurse include?

Heel warming increases capillary blood flow, improving sample accuracy and reducing hemolysis risk. Capillary glucose testing requires adequate perfusion for reliable results. Breastfeeding provides immediate glucose substrate to correct mild hypoglycemia. Normal neonatal blood glucose is >40–45 mg/dL; this newborn’s initial level of 35 mg/dL is below threshold, but responsive to feeding. Breast milk contains lactose, metabolized to glucose and galactose, supporting cerebral energy demands.

Rationale for incorrect Response 1 options: Administer glucose gel is appropriate only if feeding fails or glucose remains <25 mg/dL in asymptomatic or <40 mg/dL in symptomatic neonates. This newborn improved with feeding. Start IV fluids is reserved for persistent hypoglycemia or symptomatic neonates unresponsive to oral intake. The newborn stabilized post-breastfeeding. Phototherapy treats hyperbilirubinemia, not hypoglycemia. No bilirubin levels or jaundice signs were reported.

Rationale for incorrect Response 2 options: Supplement with formula is secondary to breastfeeding unless maternal milk is unavailable or ineffective. Breastfeeding was successful post-latch correction. Administer insulin is contraindicated; insulin lowers glucose and is used only in hyperglycemia. Monitor for jaundice is unrelated to hypoglycemia management unless bilirubin levels are elevated. No clinical jaundice was noted.

Take-home points:

• Neonatal hypoglycemia is defined as glucose <40–45 mg/dL; early feeding is first-line intervention.
• Macrosomic infants (birth weight >4,000 g) are at risk due to hyperinsulinemia post-placental glucose withdrawal.
• Differentiate hypoglycemia from sepsis, hypothermia, and metabolic disorders—all may present with jitteriness and hypotonia.
• Capillary sampling requires heel warming to ensure perfusion and accurate glucose measurement.

Choice A rationale

. Applying oxygen is a supportive measure for the client experiencing significant blood loss and circulatory compromise, but it is not the highest priority action to stop the hemorrhage. The physiological basis for applying oxygen is to maximize the oxygen content of the circulating blood, addressing tissue hypoxia secondary to hypovolemic shock.

Choice B rationale

. Weighing the perineal pad is a necessary step to accurately quantify blood loss (1 gram of weight equals approximately 1 milliliter of blood) for accurate diagnosis of postpartum hemorrhage (PPH) and to guide treatment. However, it is an assessment and documentation action, not the most critical intervention to immediately address the source of the bleeding.

Choice C rationale

. Performing a fundal massage is the highest priority and most critical intervention when a client reports rapid and heavy postpartum bleeding, which suggests uterine atony (a soft, boggy uterus). Uterine atony is the most common cause of early postpartum hemorrhage, and manual stimulation immediately causes the uterine muscle fibers to contract, which constricts the blood vessels and rapidly reduces blood loss.

Choice D rationale

. Monitoring urine output is an important assessment of renal perfusion and fluid status, which is essential to track the progression of potential hypovolemic shock due to hemorrhage. A urine output of less than 30 mL/hour suggests inadequate renal perfusion. However, this is an assessment and a later indicator of the severity of shock, not the immediate, life-saving intervention needed to halt the bleeding source.