A nurse is counseling a woman about postpartum blues. Which of the following should be included in the discussion?

A) Have the client void, then reassess the fundus:
A fundus that is firm but shifted to the right of the midline is a common sign of bladder distention. After childbirth, the bladder may fill with urine, which can displace the uterus and cause it to deviate from the midline, typically to the right. The first step in managing this situation is to have the client void to relieve the bladder distention, which often resolves the uterine shift. Once the bladder is empty, the nurse should reassess the fundus to see if the position returns to midline and remains firm. This is a non-invasive and effective initial intervention.

B) Encourage the client to ambulate:
Encouraging the client to ambulate could be beneficial for overall recovery, but it is not the priority action in this case. The issue at hand is a shifted fundus likely due to bladder distention, which should be addressed by encouraging the client to void first. Ambulation can be considered later when the immediate concern of bladder distention is managed.

C) Notify the healthcare provider:
While notifying the healthcare provider may be necessary if the issue persists after voiding or if there are other signs of complications, it is not the first step. The nurse should first attempt to resolve the issue through bladder emptying, as this is the most common cause of the shift in the fundus. If the problem persists after this, then further steps, including notifying the healthcare provider, would be appropriate.

D) Obtain an order for oxytocin:
Oxytocin is typically administered to help with uterine contraction and involution. However, since the fundus is firm and the primary issue appears to be bladder distention, administering oxytocin is not indicated at this time. The priority is to address the likely cause of the fundus being shifted, which is a full bladder. If the issue persists after voiding, then further intervention such as administering oxytocin may be considered.

A) Axillary temp of 96.9F (36.0 C) after 30 minutes of skin-to-skin contact with the mother:
A temperature of 96.9°F (36.0°C) is lower than the expected normal range for a newborn, which is typically between 97.7°F (36.5°C) and 99.5°F (37.5°C). However, after 30 minutes of skin-to-skin contact with the mother, the temperature is likely to increase as the infant benefits from the warmth of the mother's body. If the temperature does not rise or if it continues to decrease, further intervention would be necessary.

B) Respiratory rate of 58 during assessment at beginning of shift:
Newborns may have slightly irregular and rapid breathing patterns, especially right after birth, but this is not a cause for concern unless accompanied by signs of respiratory distress, such as retractions, flaring, or grunting.

C) Heart rate of 162 while crying vigorously after a diaper change:
It is not uncommon for a newborn to have an elevated heart rate when upset or crying. A heart rate of 162 while crying is expected and does not indicate a problem. Once the baby calms down, the heart rate will likely return to its baseline.

D) No void after 8 hours of life:
The absence of a urine output within the first 8 hours of life is concerning and requires immediate follow-up. Newborns typically void within the first 24 hours, and if there is no urine output by 8 hours, it could indicate a potential problem such as dehydration, urinary tract obstruction, or renal dysfunction. A healthcare provider should be notified promptly for further assessment and intervention.