A 39 year-old is status post a right radical mastectomy 2 days ago. As part of the discharge teaching, the nurse would instruct the client to avoid what activity?

A. Ice application does not decrease lochia. Lochia is the normal postpartum vaginal discharge consisting of blood, mucus, and uterine tissue. Its flow is regulated by uterine contractions and involution, not by external cooling. Ice has no impact on the volume, color, or duration of lochia.

B. Ice does not provide a painful effect; rather, it provides a pain-relieving or numbing effect by slowing nerve conduction in the area. While clients may feel temporary numbness, the purpose is analgesia, not inducing pain. The cold temperature can help reduce discomfort from perineal trauma, such as lacerations, episiotomies, or swelling.

C. Decreasing edema is the primary purpose of applying ice to the perineum after vaginal delivery. Ice causes vasoconstriction, which limits blood flow to the tissues, thereby reducing swelling and inflammation. Edema is common in the first 24 hours postpartum, especially after traumatic births, large babies, or prolonged pushing, and can contribute to pain and discomfort. Applying ice also helps minimize hematoma formation and can improve the client’s comfort during the early postpartum period. Ice therapy is typically recommended for 15–20 minutes at a time in the immediate postpartum period for optimal effectiveness.

D. Ice does not cleanse the perineum. Perineal hygiene is maintained through separate interventions such as peri-bottle rinsing, sitz baths, or gentle cleansing with warm water. Ice therapy only addresses swelling and discomfort, not infection control or cleanliness.

A. Maintain euglycemia is the most important preconception recommendation for women with pregestational diabetes. Achieving optimal blood glucose control before conception and during early pregnancy significantly reduces the risk of congenital anomalies, spontaneous abortion, and other maternal-fetal complications.

B. Increasing weight by 45 pounds is incorrect. Excessive weight gain is not recommended prior to conception. Weight should be optimized based on BMI and individual health status, not arbitrary high gain. Overweight or obesity can worsen insulin resistance and increase pregnancy risks.

C. Weight loss of at least 40% is unrealistic and unnecessary. Modest, goal-directed weight loss before conception may improve glycemic control, but an extreme reduction like 40% of body weight is unsafe and not recommended.

D. Workout at least 3 times a week is recommended to improve insulin sensitivity, maintain a healthy weight, and support cardiovascular health. Physical activity is a safe and effective strategy for preconception glycemic management unless contraindicated.

E. Dietary management is critical in diabetes care. A balanced, individualized nutrition plan helps maintain euglycemia, prevent excessive weight gain, and ensure adequate nutrient intake for maternal and fetal health.