A nurse is caring for a newborn who is 5 days old.
Medical History

History of maternal opioid use prior to pregnancy and prescribed methadone use during pregnancy. Maternal and neonatal positive urine drug screens for methadone. Newborn is exhibiting clinical findings of neonatal abstinence syndrome (NAS).


Which of the following actions should the nurse take? Select all that apply.

A: Administering an IV bolus of lactated Ringer's is typically used to correct electrolyte imbalances or as a volume expander in the case of blood loss. In peripartum cardiomyopathy, fluid overload should be avoided as it can exacerbate heart failure symptoms.
B: Misoprostol is used to prevent or treat postpartum hemorrhage, but it is not directly related to the management of peripartum cardiomyopathy.

C. Assess blood pressure twice daily:
While monitoring blood pressure is important for overall cardiovascular management, assessing it only twice daily is insufficient for a client with peripartum cardiomyopathy. This condition requires frequent and comprehensive monitoring of vital signs, fluid balance, and cardiac function to prevent complications.

D. Restrict daily oral fluid intake:
Restricting fluid intake is a key intervention in managing peripartum cardiomyopathy because it helps to prevent fluid overload, which could exacerbate heart failure. Clients with this condition often experience reduced cardiac output, and limiting fluids can reduce the strain on the heart and improve overall management of symptoms

A. While an autopsy can be an option for determining the cause of stillbirth, it is not a requirement, and the decision should be made by the parents. This statement may add undue pressure on the client.

B. There is no legal requirement for parents to name a stillborn fetus. This can be a sensitive topic, and it is essential to respect the parents' wishes and feelings in this regard.

C. Providing the client with photos of the fetus can help the parents in their grieving process, allowing them to create memories and acknowledge their loss. This action can offer emotional support and validation of their experience.

D. Limiting the time the fetus is in the client's room may not consider the parents' need for closure and the opportunity to say goodbye. Encouraging the family to spend time with their stillborn child can be an important aspect of the grieving process.