A nurse on the labor and delivery unit is planning care for a client who has human immunodeficiency virus (HIV). Which of the following is an appropriate action for the nurse to take following the birth of the newborn?

Preparing a toddler for a new sibling can be challenging, but there are some strategies that can help ease the transition and reduce the risk of jealousy or resentment. One of these strategies is to make any major changes in the toddler's routine or environment well before the baby arrives, such as moving to a new bed, starting preschool, or toilet training. This can help the toddler adjust to the change without feeling displaced or threatened by the baby. It can also prevent the toddler from associating the change with the baby and blaming the baby for it¹².

Moving a toddler to a new bed 2 months before the baby comes home is a good example of this strategy. It gives the toddler enough time to get used to sleeping in a different place and feeling comfortable and secure in it. It also avoids making the toddler feel like they are being kicked out of their bed to make room for the baby. The toddler may even feel proud of having a big-kid bed and being more independent¹².

The other options are not appropriate responses by the nurse because they may have negative effects on the toddler's adjustment to the new sibling:

a) "Let your toddler see you carrying the baby into the home for the first time." This is not a good idea because it may make the toddler feel left out or replaced by the baby. The toddler may not understand why they were not with you when you brought the baby home and may feel hurt or angry. A better option is to have someone else carry the baby into the home while you greet your toddler with a hug and a smile. Then, you can introduce your toddler to their new sibling and involve them in welcoming and caring for the baby¹³.

b) "Avoid bringing your toddler to prenatal visits." This is not a good idea because it may make the toddler feel excluded or curious about what is going on. Bringing your toddler to some of your prenatal visits can help them learn more about the baby and feel more connected to them. You can show your toddler pictures of the baby's development, let them hear the baby's heartbeat, or ask them to help you choose clothes or toys for the baby. However, you should also be prepared for your toddler's possible boredom or impatience during long or boring appointments and bring some snacks or activities to keep them entertained¹⁴.

c) "Require scheduled interactions between the toddler and the baby." This is not a good idea because it may make the toddler feel pressured or resentful toward the baby. Forcing your toddler to interact with the baby when they are not ready or interested can backfire and cause more conflict or distance between them. A better option is to follow your toddler's cues and let them decide how much and when they want to interact with the baby. You can also praise your toddler for any positive interactions they have with the baby, such as giving them a gentle kiss, sharing a toy, or singing a song¹³.

A newborn who is exposed to HIV perinatally should be bathed and cleansed of maternal secretions as soon as possible after birth to reduce the risk of HIV transmission through the skin or mucous membranes¹². The newborn should also receive antiretroviral prophylaxis within six hours of delivery, preferably within two hours¹². The type and duration of prophylaxis depend on the maternal and infant factors that influence the risk of HIV transmission, such as maternal viral load, antiretroviral therapy, mode of delivery, and infant gestational age¹²³. The newborn should also undergo HIV testing at birth, at 14 to 21 days of age, at one to two months of age, and at four to six months of age¹².

The other options are incorrect because:
b) Initiating contact precautions for the newborn is not necessary or recommended. Contact precautions are used to prevent the spread of infections that are transmited by direct or indirect contact with the patient or the patient's environment. HIV is not transmited by casual contact, and standard precautions are sufficient to prevent exposure to blood or body fluids that may contain HIV¹².
c) Administering intravenous antibiotics to the newborn is not indicated for HIV prevention. Antibiotics are used to treat bacterial infections, not viral infections like HIV. Antibiotics may be given to the newborn for other reasons, such as suspected sepsis or chorioamnionitis, but they do not affect the risk of HIV transmission¹².
d) Encouraging the mother to breastfeed her newborn is contraindicated for HIV prevention. Breastfeeding can transmit HIV from the mother to the infant through breast milk, especially if the mother has a high viral load, mastitis, cracked nipples, or oral lesions in the infant. In resource-limited settings where formula feeding may not be feasible or safe, breastfeeding with maternal or infant antiretroviral therapy may be considered, but in developed countries where safe alternatives are available, breastfeeding is not recommended for mothers with HIV infection¹².