A nurse is assisting in the care of a newborn.

Exhibits

A nurse is reinforcing discharge education with the parents of a newborn. For each potential point, click to specify if the teaching is anticipated or contraindicated for the newborn.

A) Offering opioids followed by topical treatment:
While opioids can be effective for pain, they are typically reserved for more severe pain and are not the first line of treatment for the moderate pain commonly experienced postpartum, especially after a first-degree laceration. A stepwise approach emphasizes starting with less potent options and progressing as needed, so offering opioids first is not appropriate here.

B) Offering mindfulness only for pain:
While mindfulness and other non-pharmacological techniques can be helpful for pain management, offering only mindfulness as the sole approach may not adequately address the client's pain, especially in the early postpartum period. A stepwise approach typically involves combining pharmacological and non-pharmacological methods to achieve effective pain relief, so relying only on mindfulness is not the most effective strategy for this situation.

C) Giving the highest dose of opioids to make sure to eliminate the pain:
Stepwise pain management involves starting with the least invasive and least potent option, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and escalating treatment if necessary. Using high doses of opioids first can lead to unnecessary side effects and risks, especially when less potent options would suffice.

D) Starting with ibuprofen for pain management and adding cold therapy for additional relief:
This is an example of a stepwise approach to pain management. Starting with ibuprofen, an NSAID, addresses inflammation and mild to moderate pain effectively, which is appropriate for a first-degree laceration. Cold therapy can be added for additional relief, as it helps reduce swelling and numb the area, which can further reduce discomfort. This combination of pharmacological and non-pharmacological treatments follows the principle of starting with less potent options and adding more if needed, making it the best choice.

A) At the umbilicus:
After delivery, the fundus is typically located at or just below the umbilicus in the immediate postpartum period, but it will gradually descend over the next few days. By 8 hours postpartum, the fundus is often slightly below the umbilicus, not directly at the umbilicus. The fundus will continue to shrink in size and move downward toward the pelvic region as the uterus contracts and involutes.

B) At a non-palpable depth:
A fundus that is non-palpable is generally expected later in the postpartum period, typically by 10-14 days after delivery, as the uterus contracts and returns to its pre-pregnancy size. At 8 hours postpartum, the fundus is still palpable, generally just below the umbilicus, and should be evaluated for firmness and position.

C) Just above the symphysis pubis:
The fundus is usually higher than the symphysis pubis at 8 hours postpartum, as it is still in the process of descending from the higher position it occupied during pregnancy. It would be expected to be just below the umbilicus or about 1 to 2 finger widths below it. By the second or third day postpartum, the fundus begins to move lower toward the symphysis pubis as it continues to involute.

D) Just below the umbilicus:
Eight hours after delivery, the nurse should expect to palpate the fundus just below the umbilicus. This is a typical finding as the uterus begins to contract and shrink after the delivery of the placenta. The fundus will descend about 1-2 cm per day postpartum, so by 8 hours, it is usually just slightly below the level of the umbilicus.