Exhibits

Based on the client's history and physical, the nurse notes that this postpartum client is most at risk for developing

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and

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.

A. A High-Fowler's with the arm on the operative side elevated on pillows: While elevating the arm is important, a high-Fowler's position may cause unnecessary strain on the surgical site and is not recommended for comfort and healing in the immediate postoperative period.

B. Semi-Fowler's with the arm on the operative side in a dependent position: Keeping the arm in a dependent position can increase the risk of swelling and lymphedema, which should be avoided after a mastectomy.

C. High-Fowler's with the arm on the operative side in a dependent position: The high-Fowler's position, combined with keeping the arm in a dependent position, would likely increase swelling and discomfort and is not recommended postoperatively.

D. Semi-Fowler's with the arm on the operative side elevated on pillows: The semi-Fowler's position is ideal for comfort and healing, and elevating the arm helps reduce the risk of lymphedema by encouraging proper drainage and circulation post-surgery. This is the most appropriate position to promote recovery.

Rationale for correct choices:

• Cord compression: The decelerations in fetal heart rate (FHR) are more likely caused by cord compression, which can result in transient reductions in oxygen supply. The decelerations, although brief, point to this as the most probable cause.
• Change position (side to side, knee-chest): Changing the maternal position can help relieve pressure on the umbilical cord, improving blood flow and oxygenation to the fetus. Positions like side-to-side or knee-chest can be especially effective in relieving cord compression.
• Oxygen at 10 L via nonrebreather face mask: Administering oxygen to the mother helps increase oxygen supply to the fetus. This can be particularly helpful in cases of cord compression where fetal oxygenation may be compromised.
• Length of time FHR takes to return to baseline: Monitoring the length of time for the FHR to return to baseline after decelerations helps assess the severity of fetal distress. Prolonged or persistent decelerations may indicate worsening fetal compromise.
• Frequency of decelerations: The nurse should monitor how often the decelerations occur. Frequent or persistent decelerations may require more aggressive interventions and provide insights into the underlying cause (e.g., cord compression).

Rationale for incorrect choices:

• Prepare for operative delivery: The priority is addressing the possible cord compression through maternal positioning and oxygenation. Operative delivery is not necessary unless the situation does not improve or worsens significantly.
• Assess maternal blood glucose: While maternal blood glucose may impact fetal well-being, the primary issue in this case appears to be cord compression, which requires positional changes and oxygen rather than glucose management.
• Decrease IV rate: There is no indication that the IV rate is contributing to the FHR decelerations. In fact, maintaining hydration and ensuring adequate blood volume is important, especially in labor, so decreasing the IV rate is not appropriate.

• Placenta previa: Placenta previa would present with vaginal bleeding and is not suggested by the current symptoms. FHR decelerations are more consistent with cord compression.
• Fetal reaction to pain medication: There is no evidence of maternal pain medication administration, and the decelerations appear to be caused by cord compression, not medication effects.
• Head compression: Head compression typically causes quick, variable decelerations, while these appear more gradual and are consistent with cord compression.
• Maternal blood pressure: The maternal blood pressure is stable and does not seem to be causing the FHR decelerations, which are likely due to cord compression.
• Cervical dilation and effacement: Cervical changes are important for labor progress but do not affect the FHR decelerations, which are related to cord compression.
• Strength of contractions: The strength of contractions is not the cause of the decelerations. Cord compression is the primary issue, not uterine contractions.