A nurse is teaching a client who is postpartum about home safety for her newborn. Which of the following Instructions should the nurse include?

A. Assist the client to the left lateral position: Repositioning improves uteroplacental perfusion, especially in the presence of variable decelerations. The left lateral position relieves pressure on the inferior vena cava, promoting fetal oxygenation.

B. Administer oxygen at 10 L/min via nonrebreather face mask: Oxygen is indicated to improve fetal oxygenation during nonreassuring FHR patterns like recurrent variable decelerations and minimal variability, both of which are present in this scenario.

C. Notify the provider of the client's condition: The combination of recurrent variable decelerations, minimal variability, and a history of meconium-stained fluid warrants immediate provider notification to assess further interventions and potential fetal compromise.

D. Request a prescription for oxytocin: Oxytocin stimulates uterine contractions and may worsen fetal distress in the presence of variable decelerations or minimal variability. It is contraindicated until the fetal status is stabilized.

E. Request a prescription for hydralazine: Hydralazine is used to treat hypertension. The client’s blood pressure is within normal range and does not require antihypertensive management at this time.

F. Prepare to administer an amnioinfusion: Amnioinfusion is indicated to dilute meconium-stained amniotic fluid and relieve cord compression, both of which are suggested by the variable decelerations and green-stained fluid earlier.

G. Initiate a bolus of IV fluid: IV fluid bolus improves maternal blood volume and uteroplacental perfusion, which can help resolve variable decelerations and increase fetal oxygenation during nonreassuring FHR patterns.

• Inspect the child’s oropharynx:After vomiting bright red blood, inspection can help confirm if bleeding is active in the throat. This assessment is key in identifying post-tonsillectomy hemorrhage.
• Obtaining a set of vital signs:Vital signs help evaluate the child’s hemodynamic stability, monitor for hypovolemic shock, and guide urgency for provider notification or surgical intervention.

Rationale for Incorrect Choices:

• Offer the child a red popsicle:Red-colored foods can mask signs of active bleeding. Also, offering oral intake during suspected hemorrhage is unsafe and may increase risk of aspiration.
• Place the child in a supine position:Supine positioning can increase aspiration risk if bleeding continues or worsens. The child should remain upright to protect the airway.
• Requesting a prescription for codeine:Codeine is not indicated in this situation and is contraindicated in children post-tonsillectomy due to risk of respiratory depression, especially during bleeding.
• Encouraging the child to cough and deep breathe:Coughing may dislodge clots and worsen bleeding. This action is inappropriate when bleeding is suspected in the oropharynx.