A nurse is planning discharge teaching for a postpartum client, Which of the following information should the nurse include for the client experiencing constipation?

Rationale:

A. Cyanosis, fatigue with feeds, and diminished breath sounds is incorrect because ventricular septal defect (VSD) typically causes a left-to-right shunt, which does not initially produce cyanosis. Cyanosis is more characteristic of cyanotic congenital heart defects, such as Tetralogy of Fallot. Diminished breath sounds are not a hallmark of VSD.

B. Cyanosis, murmur, and weight loss is incorrect for the same reason: infants with a VSD are usually acyanotic at rest. Weight loss may occur if heart failure develops, but cyanosis is not typical for isolated VSD.

C. Murmur, tachypnea, and wheezing is incorrect because wheezing is more indicative of respiratory conditions such as bronchiolitis or asthma. While tachypnea and murmur can occur with VSD, wheezing is not a consistent clinical manifestation.

D. Murmur, tachycardia, and fatigue with feeds is correct because these are classic manifestations of VSD. A holosystolic murmur is usually audible along the left lower sternal border due to turbulent blood flow across the defect. Tachycardia and fatigue with feeding occur because the heart works harder to pump blood, leading to increased pulmonary blood flow and decreased systemic perfusion during exertion. Infants may also experience poor weight gain and signs of congestive heart failure if the defect is significant.

Rationale:

A. Administering nebulized albuterol is correct because it is a short-acting beta-agonist (SABA) that provides rapid bronchodilation. During an acute asthma exacerbation, airway constriction is the immediate threat to oxygenation. According to Airway-Breathing-Circulation (ABC) priorities, relieving bronchospasm to restore airflow takes precedence over other supportive measures. Prompt administration of albuterol can quickly improve ventilation, reduce wheezing, and stabilize the patient.

B. Providing immediate rest for the client is incorrect because while reducing physical activity can help conserve energy, it does not directly relieve bronchospasm or improve airflow. Rest alone is not sufficient during an acute exacerbation.

C. Positioning the client in high-Fowler's is incorrect as a sole intervention because it can assist with breathing by maximizing lung expansion, but it does not treat the underlying airway constriction, which is the priority during an acute exacerbation.

D. Initiating oxygen therapy is incorrect as the highest priority in this scenario. Oxygen helps maintain oxygen saturation, but if the airway remains constricted due to bronchospasm, oxygen delivery alone will not correct hypoxemia effectively. Bronchodilation with albuterol addresses the root cause of airflow obstruction.