Your patient presents to labor and delivery with opioid use disorder and is taking methadonE. The best treatment for her baby that will develop neonatal abstinence syndrome is:

Choice A: Explaining to the client what is happening over the next few minutes in detail and asking for teach back from the spouse is not the first action, as it may delay the urgent intervention and increase the anxiety of the client and the spousE. The nurse should provide brief and clear information and reassurance after taking the first action.

Choice B: Placing the client in a knee-chest or Trendelenburg position and raising the presenting part off the cord with your hand is the first and most important action, as it relieves the pressure on the cord and prevents cord compression and fetal hypoxiA. The nurse should maintain this position until the delivery.

Choice C: Covering the cord with a sterile, moist saline dressing is a secondary action, as it prevents the cord from drying and reduces the risk of infection. The nurse should perform this action after taking the first action.

Choice D: Preparing the client for an emergency cesarean birth is a tertiary action, as it is the definitive treatment for cord prolapse and ensures the safety of the mother and the fetus. The nurse should perform this action after taking the first and second actions.

A. Call the lactation consultant to visit the patient

Rationale: A lactation consultant is a specialized professional who can provide expert guidance on breastfeeding techniques and troubleshooting latching issues. They can offer personalized assistance and support to ensure proper latch and feeding.

B. Encourage and support the mother's desire/intention and include the partner in the conversation

Rationale: Providing emotional support and encouragement is crucial. Including the partner helps create a supportive environment for the mother and ensures that everyone is on the same page regarding breastfeeding goals and practices.

E. Check for audible swallowing and a comfortable (non-painful) suck

Rationale: Ensuring that the baby is swallowing and that the mother is not experiencing pain during feeding indicates that the latch may be correct. This helps confirm that the baby is feeding effectively and that the mother is comfortable.

Not Recommended:

C. Give the mother a bottle of formula to supplement

Rationale: Introducing formula supplementation is not necessary if the goal is exclusive breastfeeding. This step might undermine the mother's confidence or interfere with the baby's ability to latch properly.

D. Help the mother shove her nipple in the baby's mouth

Rationale: This approach can cause discomfort and may not address the underlying issue of improper latching. It is better to use techniques that encourage a natural and comfortable latch.

Note:

F. Assist with proper positioning and latch techniques"

Rationale:Proper positioning ensures the baby is comfortably aligned with their head in line with their body, and the baby is brought to the breast, not vice versa.

A good latch involves the baby opening their mouth wide to take in the nipple and a portion of the areola, which helps with milk transfer and reduces discomfort. Proper latch prevents pain and supports milk production.