A breastfeeding mother returns to work when her infant is 5 months old. She is having difficulty pumping enough milk to meet her infant's dietary requirements.

Which suggestion should the nurse provide to this mother?

• Estimated blood loss of 750 mL at delivery
  • Although below the 1,000 mL threshold for major PPH, this amount is still significant for a vaginal delivery and may contribute to anemia and ongoing bleeding symptoms.
• Labor lasted 50 hours with vacuum-assisted delivery
  • Prolonged labor and instrumental delivery are known risk factors for uterine atony and trauma, both of which can lead to PPH2.
• Second-degree perineal laceration and left lateral sulcus laceration
  • These injuries can contribute to bleeding, especially if not adequately repaired or if bleeding persists from the site.

Choice A rationale

While ensuring that preoperative laboratory results are available is a necessary step in the preoperative process, it is not the most immediate action. The client's consumption of coffee at 0400 violates the NPO (nil per os) guidelines, which is a significant safety concern. The immediate priority is to address the NPO violation with the appropriate healthcare provider.

Choice B rationale

Starting a prescribed IV with lactated Ringer's is part of the standard preoperative preparation. However, this action is secondary to addressing the NPO violation. The client's safety is compromised by the recent ingestion of fluids, and this issue must be communicated to the anesthesia care provider before any further interventions, including IV fluid administration, are initiated.

Choice C rationale

While the obstetrician should be informed of the NPO violation, the anesthesia care provider is the most critical person to notify first. Anesthesia for a C-section is significantly impacted by the client's NPO status. The risk of aspiration pneumonia during intubation is greatly increased with recent oral intake. The anesthesia provider will determine the appropriate course of action, which may include delaying the procedure.

Choice D rationale

The anesthesia care provider must be informed immediately because the client's NPO status is a critical factor in safe anesthesia administration. Ingestion of fluids within two hours of surgery increases the risk of pulmonary aspiration of gastric contents, which can lead to serious complications such as chemical pneumonitis and acute respiratory distress syndrome. The anesthesia provider needs this information to assess risk and determine if the procedure needs to be postponed.