A nurse is teaching about home safety with a client who is 2 days postpartum. Which of the following instructions should the nurse include in the teaching?

Rationale:

A. An apneic episode less than 15 seconds may be considered within normal limits for a newborn and does not necessarily indicate a decline in status.

B. Fine crackles may indicate fluid in the lungs but are not specific to a decline in the newborn's status.

C. An oxygen saturation of 89% indicates hypoxemia, which is a significant concern and suggests respiratory compromise. It indicates a decline in the newborn's status and requires immediate intervention to improve oxygenation.

D. Nasal flaring is a sign of respiratory distress but may not be as concerning as a low oxygen saturation level in this context. It indicates increased work of breathing but does not provide direct information about oxygenation status.

Rationale:

A. Inserting a urinary catheter is an invasive procedure and should not be the first action taken to address bladder distention following a vaginal birth. It should only be considered if the client is unable to void voluntarily.

B. Assisting the client to the bathroom is the initial intervention to attempt to relieve bladder distention. Encouraging the client to void in a comfortable and familiar environment may stimulate urination and help alleviate the distention.

C. Offering the client a sitz bath may provide comfort and promote perineal healing but is not the first intervention for bladder distention.

D. Pouring warm water over the client's perineum may also provide comfort but does not directly address bladder distention.