A nurse is teaching a client who has multiple sclerosis. Which of the following instructions should the nurse include in the teaching?

Rationale:

A. Butorphanol tartrate: This opioid analgesic can cause respiratory depression in the newborn if given too close to delivery. At 10 cm dilation and during pushing, it's generally too late to administer systemic opioids safely.

B. Pudendal block: A pudendal block provides localized perineal anesthesia and is safe for use during the second stage of labor when the client is fully dilated and pushing. It effectively reduces pain from stretching and pressure without affecting uterine contractions or fetal status.

C. Naloxone hydrochloride: Naloxone is not a pain-management measure; it is an opioid antagonist used to reverse opioid-induced respiratory depression. It does not provide analgesia and is not administered for pain relief during labor.

D. Spinal anesthesia: Spinal anesthesia is typically administered prior to a planned cesarean birth or late in the first stage of labor. It is not appropriate once the client is fully dilated and actively pushing, as it could delay delivery and complicate maternal positioning.

Rationale:

A. Providing the client with information about transportation services: This helps address access barriers but focuses on support services rather than directly organizing or integrating healthcare delivery, which is central to coordination of care.

B. Informing the client about providers who accept their health insurance: While helpful, this action centers on financial guidance. It supports access but does not actively bridge or organize care among multiple services or settings.

C. Arranging an appointment for the client with a mobile health clinic: Coordinating an appointment directly connects the client with needed services, especially in underserved rural areas. This reflects active care coordination by ensuring timely access to care and reducing system fragmentation.

D. Encouraging the client to become a self-advocate: Promoting self-advocacy empowers the client in their health journey but does not represent coordination of care. Coordination involves organizing and facilitating access across providers and settings.