A nurse is monitoring a client who is 3 days postpartum and is breastfeeding. The nurse notes that the fundus is three fingerbreadths below the umbilicus, lochia rubra is moderate, and the breasts are full and warm to palpation. Which of the following interpretations of these findings should the nurse make?

Choice A reason:

Dyspnea: Dyspnea, or difficulty breathing, is a serious adverse effect that should be reported immediately. Terbutaline can cause pulmonary edema, a condition where fluid accumulates in the lungs, leading to severe breathing difficulties. This side effect is critical and requires prompt medical attention to prevent further complications.

Choice B reason:

Headaches: While headaches are a common side effect of terbutaline, they are generally not considered severe enough to require immediate reporting unless they are persistent or unusually intense. Headaches can be managed with over-the-counter pain relief and do not typically indicate a serious problem.

Choice C reason:

Nervousness: Nervousness is another common side effect of terbutaline. It is usually mild and does not require immediate medical intervention. However, if the nervousness is severe or accompanied by other symptoms, it should be discussed with a healthcare provider.

Choice D reason:

Tremors: Tremors are a known side effect of terbutaline and are usually not severe. They occur due to the medication’s action on the nervous system. While they can be bothersome, they are not typically dangerous and do not require urgent reporting unless they are severe or persistent.

Choice A reason:

Observing for meconium in respiratory secretions is crucial for newborns who are small for gestational age (SGA). Meconium aspiration syndrome (MAS) is a significant risk for these infants. Meconium, the first stool of an infant, can be passed into the amniotic fluid before or during labor, especially in cases of fetal distress. If the newborn inhales this meconium-stained fluid, it can lead to severe respiratory issues, including airway obstruction, inflammation, and infection. Therefore, careful monitoring and immediate intervention are necessary to prevent complications associated with MAS.

Choice B reason:

Monitoring for hyperthermia is not typically a primary concern for SGA infants. These infants are more prone to hypothermia due to their lower body fat and reduced ability to regulate body temperature. While maintaining a stable temperature is essential, the risk of hyperthermia is less common compared to hypothermia. Therefore, this intervention is not as critical as others for SGA infants.

Choice C reason:

Identifying manifestations of anemia is important but not the most immediate concern for SGA infants. Anemia can occur in these infants due to various factors, including intrauterine growth restriction and maternal conditions. However, the immediate postnatal period requires more urgent interventions, such as monitoring for respiratory distress and hypoglycemia. Anemia can be assessed and managed as part of the ongoing care plan.

Choice D reason:

Monitoring for hyperglycemia is not a primary concern for SGA infants. In fact, these infants are at a higher risk of hypoglycemia due to their limited glycogen stores and increased metabolic demands. Hypoglycemia can lead to serious complications, including neurological damage if not promptly addressed. Therefore, monitoring blood glucose levels and ensuring adequate nutrition are critical interventions for SGA infants.