The nurse is continuing to care for the client.

Exhibits

The nurse is initiating the client's plan of care. Which of the following interventions should the nurse plan to implement? Select all that apply.

Rationale:

A. "Begin each feeding using the same breast.": It's recommended to alternate breasts between feedings to ensure both breasts are emptied regularly. This helps maintain milk production and prevents engorgement or blocked ducts.

B. "Supplement breastfeedings with water every 12 hours.": Newborns do not require supplemental water. Breast milk provides all the necessary hydration and nutrients for the infant’s needs, even in hot weather.

C. "Offer your infant the breast when he shows signs of hunger.": Feeding on demand based on hunger cues—such as rooting, sucking motions, or hand-to-mouth activity—supports adequate nutrition, growth, and milk supply.

D. "Limit the time your infant feeds to 10 minutes on each breast.": Feeding should not be time-restricted. Infants should be allowed to feed until they are satisfied, as some may take longer to extract enough milk, especially in the early weeks.

Rationale:

A. Temperature: The client's temperature decreased from 38.6°C (101.5°F) to 37.1°C (98.9°F), indicating that the febrile response to infection has resolved. This trend supports the effectiveness of the antibiotic therapy initiated on postpartum day 3.

B. Hgb: Hemoglobin dropped from 11.1 to 10 g/dL, which may reflect continued postpartum blood loss or hemodilution. This decline does not indicate improvement and may require monitoring for worsening anemia.

C. Heart rate; Heart rate improved from 110/min to 78/min, demonstrating reduced physiologic stress and better cardiovascular stability. This aligns with the drop in temperature and suggests systemic recovery from infection.

D. Fundal height; The fundus decreased from 1 cm above the umbilicus to 4 cm below, showing normal postpartum involution. A firm, midline uterus without excessive tenderness also supports clinical improvement.

E. Lochia: Lochia changed from moderate, dark brown, and foul-smelling to a small amount of brownish-red with no odor, which suggests resolving endometrial infection. This progression is typical in healthy postpartum recovery.

F. WBC count: The WBC count normalized from 33,000/mm³ to 10,000/mm³, reflecting resolution of systemic inflammation or infection. This is consistent with decreasing temperature and improved vital signs.