A nurse is caring for a client who received meperidine (Demerol) IV for pain relief during labor 2 hours ago and is now ready to deliver vaginally.

Which of the following medications should the nurse have available to reverse respiratory depression in the newborn?

The correct answer is choice A, C, D and E. These are the instructions that the nurse should include in the teaching for a client who had a vaginal delivery with a midline episiotomy.

• Choice A is correct because using a sitz bath three times per day and after each bowel movement can help reduce pain, swelling and infection of the perineum.

• Choice C is correct because applying ice packs to the perineum for the first 24 hours can help reduce inflammation and bleeding.

• Choice D is correct because performing Kegel exercises several times per day can help strengthen the pelvic floor muscles and improve urinary continence.

• Choice E is correct because reporting any increase in redness, swelling or discharge from the episiotomy site can help detect signs of infection or wound breakdown.

• Choice B is wrong because wiping from back to front after voiding or having a bowel movement can increase the risk of infection by introducing bacteria from the anal area to the vaginal area.The correct way to wipe is from front to back.

Increased sleepiness and difficulty waking up are signs of central nervous system (CNS) depression in breastfed infants exposed to codeine through breast milk.Codeine is converted into morphine in the body, which can pass into breast milk and cause adverse effects in the baby.Codeine use by breastfeeding mothers can cause CNS depression in breastfed infants.

Therefore, the nurse should watch for increased sleepiness and difficulty waking up in the baby.

Choice A is wrong because increased alertness and activity are not signs of CNS depression.

They are more likely to be signs of stimulation or agitation.

Choice B is wrong because decreased appetite and weight gain are not specific signs of codeine exposure.

They can be caused by many other factors, such as illness, infection, or poor latch.

Choice C is wrong because increased respiratory rate and depth are not signs of CNS depression.

They are more likely to be signs of respiratory distress or infection.

Choice D is wrong because decreased heart rate and blood pressure are not signs of CNS depression.

They are more likely to be signs of shock or hypovolemia.

Normal ranges for vital signs in newborns are:

• Heart rate: 100 to 160 beats per minute

• Respiratory rate: 30 to 60 breaths per minute