A nurse is planning care for a postpartum client who expresses a desire to follow the traditional beliefs regarding the balance of yin and yang for postpartum care.
Which of the following actions should the nurse plan to take?

Choice A rationale

Temperature instability, particularly hypothermia, is a significant indicator of neonatal hypoglycemia. Glucose is the primary metabolic fuel for thermogenesis, and its deficiency impairs the infant's ability to maintain core body temperature. The normal newborn temperature range is typically 36.5°C to 37.5°C (97.7°F to 99.5°F).

Choice B rationale

Acrocyanosis, a bluish discoloration of the hands and feet, is a common and usually benign finding in newborns, especially in the first 24-48 hours, due to immature peripheral circulation. It does not directly indicate hypoglycemia; rather, it reflects normal physiological adaptation to extrauterine life.

Choice C rationale

Jitteriness, or tremors, is a classic neurological sign of hypoglycemia in newborns. The central nervous system is highly dependent on glucose for energy, and insufficient glucose supply can lead to neuronal excitability and involuntary muscle movements. This is often an early and prominent symptom.

Choice D rationale

Hypotonia, characterized by decreased muscle tone and floppiness, can be a symptom of severe or prolonged hypoglycemia. Glucose is essential for proper neuromuscular function, and its deprivation can impair nerve impulse transmission and muscle contraction, leading to reduced muscle resistance to passive movement.

Choice E rationale

Abdominal distention is typically associated with gastrointestinal issues such as feeding intolerance, bowel obstruction, or necrotizing enterocolitis. It is not a direct or common manifestation of hypoglycemia in newborns. Hypoglycemia primarily affects metabolic and neurological systems.

Fetal hypoxia occurs when oxygen delivery to the fetus is compromised. In this client, the contraction pattern of very frequent, prolonged contractions every 1–2 minutes lasting 90–120 seconds results in uterine tachysystole, which reduces uteroplacental blood flow during contractions. Normal contraction frequency is no more than 5 contractions in 10 minutes. Excessive contractions increase uterine tone, decrease relaxation time, and limit oxygen exchange, causing fetal heart rate changes like late decelerations and minimal variability. This leads to fetal hypoxia, a critical risk in labor complicated by these contraction abnormalities.

Rationale for incorrect Response 1 options:
Abruptio placentae is a sudden placental separation causing bleeding and pain, which is not directly indicated here, as there is no vaginal bleeding or sharp pain described.
Uterine tachysystole describes the contraction pattern itself rather than a complication; it is a cause, not the adverse outcome.
Chorioamnionitis is infection of fetal membranes, usually indicated by fever and uterine tenderness, neither present here.

Rationale for incorrect Response 2 options:
Gestational hypertension contributes to fetal risk but is not the immediate cause of the current fetal distress.
Fetal heart rate variability describes fetal condition but does not cause fetal hypoxia; rather, it signals it.
Intrauterine growth restriction indicates chronic fetal compromise but is not the direct cause of acute fetal hypoxia during labor contractions.

Take home points:

• Uterine tachysystole causes reduced oxygen delivery by limiting uterine relaxation time, risking fetal hypoxia.
• Fetal hypoxia manifests as late decelerations and minimal variability on fetal monitoring.
• Abruptio placentae and chorioamnionitis have distinct clinical signs, which differ from those caused by contraction abnormalities.
• Differentiating causes of fetal distress is vital for timely intervention during labor to prevent adverse outcomes.