Share This Link

Femur: The femur is not typically involved in birth-related trauma during shoulder dystocia. This long bone is located in the thigh and is relatively well protected during delivery, making it an unlikely site for injury in this context.

Humerus: While the humerus can occasionally be fractured during difficult deliveries, especially if excessive traction is applied, it is less commonly injured than the clavicle during shoulder dystocia. Fractures of the humerus are usually secondary to more forceful maneuvers or malpositioning.

Skull: Skull fractures are rare in shoulder dystocia because the head is typically already delivered by the time the dystocia is recognized. Skull fractures are more often associated with instrumental deliveries or cephalopelvic disproportion rather than shoulder entrapment.

Human placental lactogen: Human placental lactogen (hPL) is produced by the placenta and plays a key role in modulating maternal metabolism during pregnancy. After the delivery of the placenta, hPL levels drop rapidly and are not elevated in the postpartum period.

Estrogen: Estrogen levels fall sharply after birth due to the loss of placental production. Although estrogen helps prepare breast tissue for lactation during pregnancy, its decline is necessary to allow prolactin to effectively stimulate milk production.

Progesterone: Like estrogen, progesterone is produced by the placenta and decreases significantly after delivery. Its decline removes inhibition on prolactin, thereby facilitating the onset of lactation in the postpartum period.

To take over as much as possible to relieve the pressure: Although well-intentioned, taking over decision-making may inadvertently strip the parents of their agency. This can lead to feelings of disempowerment or regret later on, as these decisions are deeply personal and form an important part of the grieving process.

To leave them alone to work things out: Completely withdrawing support during this critical moment may lead parents to feel abandoned or overwhelmed. While some time alone may be helpful, the nurse should remain present, compassionate, and available to guide and support when needed but allow the parents to maintain control..

To encourage the grandparents to take over: Involving extended family inappropriately can interfere with the grieving parents' right to process the loss in their own way. While grandparents may be emotionally invested, decisions surrounding naming and funeral arrangements are primarily the parents' to make.

Administer oxytocin infusion: Oxytocin may be indicated if uterine atony is contributing to postpartum hemorrhage, but administering it should follow a focused assessment. Giving it without first confirming uterine status may delay identification of other causes of hypotension or lead to inappropriate treatment.

Initiate oxygen therapy by nonrebreather mask: Oxygen administration may be necessary if the client shows signs of shock or poor perfusion, but it is a supportive measure. Identifying and managing the underlying cause of hypotension should take priority to prevent further hemodynamic deterioration.

Obtain a type and crossmatch: While important for preparing for possible blood transfusion, this is not the first step. Type and crossmatch should follow initial assessment and stabilization, as it does not directly address the source or immediate consequences of the hypotension.

Suction the nose with a bulb syringe: While clearing nasal secretions is important, suctioning the mouth takes priority over the nose. Stimulating the nares before clearing the oral airway can cause aspiration if secretions are present in the mouth, especially in newborns with underdeveloped airway protective reflexes.

Use a suction catheter with low negative pressure: Suction catheters are typically reserved for cases requiring deeper or more controlled suctioning, such as in NICU settings. For routine post-delivery care, a bulb syringe is the safest and most effective tool to clear the newborn’s airway without risking trauma or excessive negative pressure.

Turn the newborn on his side: Positioning the newborn on their side may aid in drainage of secretions, but it is not sufficient as a first action when secretions are visibly bubbling from the nose and mouth. Active suctioning is necessary to clear the airway and prevent obstruction or aspiration as the first step and the head should be placed in a sniffing position rather than turning.

Within 2 days: In the first 48 hours postpartum, the breasts primarily produce colostrum, a nutrient-rich, antibody-packed secretion. While highly beneficial, it is not yet considered mature milk. Most mothers do not experience full milk "coming in" this early.

In 6 to 8 days: Milk production is usually well established by this time, not just beginning. A delay beyond 5 days may be considered abnormal and could signal complications such as retained placental fragments or hormonal imbalances that may require clinical assessment.

In about 10 days: Waiting 10 days for mature milk onset is considered significantly delayed and warrants evaluation for lactation failure. Early intervention would be necessary to support breastfeeding success and ensure adequate nutrition for the newborn.

7 to 10 days after childbirth: This time frame is too delayed for the first follow-up of a breastfeeding infant. Early post-discharge visits are essential to assess feeding adequacy, hydration, and weight changes, all of which are critical within the first few days of life.

2 weeks of age: Waiting until 2 weeks may miss early signs of complications such as dehydration, excessive weight loss, or jaundice. While a 2-week visit is often part of routine pediatric care, it is not soon enough for initial post-discharge evaluation.

4 to 5 days after hospital discharge: Although closer to the recommended window, this range still allows for too much variability and may delay necessary interventions. Earlier evaluation is especially important for breastfeeding infants who may have feeding difficulties or poor weight gain.

Temperature 36.8° C, heart rate 60 bpm, respirations 18, BP 140/90 mm Hg: While the blood pressure is elevated and the heart rate is on the lower end, these findings are not uncommon postpartum and do not indicate an immediate threat. Bradycardia can occur due to increased stroke volume postpartum, and this patient shows no signs of hemodynamic compromise.

Temperature 38° C, heart rate 80 bpm, respirations 16, BP 110/80 mm Hg: A low-grade fever is often a due to hormonal shifts or dehydration. All other vitals are stable and well within normal limits. There is no indication of cardiovascular instability or need for urgent intervention.

Temperature 37.4° C, heart rate 88 bpm, respirations 36, BP 126/68 mm Hg: Although the respiratory rate is elevated, the other vital signs are stable. A respiratory rate of 36 may warrant further assessment for pain, anxiety, or early respiratory compromise, but it is not as immediately life-threatening as the hypotension and tachycardia seen in option A.