A nurse is providing discharge instructions to a client who is breastfeeding her newborn. Which of the following instructions should the nurse include?

Choice A rationale:

Instructing the client to maintain scheduled mealtimes is essential for a postpartum client with type 1 diabetes mellitus who is breastfeeding. Consistent and balanced meals help stabilize blood glucose levels, especially in diabetic clients who need to manage their insulin.

Choice B rationale:

Checking blood glucose levels every 8 hours is not appropriate for a postpartum client with type 1 diabetes mellitus. Diabetic clients typically need to monitor their blood glucose more frequently, especially after meals and during breastfeeding.

Choice C rationale:

Instructing the client to take more insulin with each meal than she did prior to pregnancy is not accurate advice. The insulin requirements may change during pregnancy, but it is essential to follow the healthcare provider's guidance on adjusting insulin doses after delivery.

Choice D rationale:

Limiting carbohydrate intake to 30 grams per day is not suitable for a breastfeeding postpartum client with type 1 diabetes mellitus. Carbohydrates are a crucial source of energy, and breastfeeding mothers usually require more carbohydrates to support lactation and energy needs. Restricting carbohydrates to such a low level could be harmful.

Choice A rationale:

Swaddling the baby tightly with his legs extended before laying him down to sleep is not a recommended practice, as it can increase the risk of hip dysplasia. Instead, the baby should be placed on their back in a safe sleep environment.

Choice B rationale:

This statement is correct because monitoring the baby's urinary output is essential in ensuring adequate hydration and proper kidney function. Less than six wet diapers a day could be a sign of dehydration and should be promptly reported to the pediatrician.

Choice C rationale:

It is not necessary to retract the foreskin to clean the baby's penis during each bath. The foreskin should be left alone and not forcibly retracted until it naturally loosens, usually around the age of 3 to 5 years.

Choice D rationale:

Applying triple antibiotic ointment on the baby's umbilical cord is not recommended, as the standard practice is to keep the umbilical cord clean and dry. This helps it to fall off naturally within a week or two after birth, reducing the risk of infection.