The lead nurse is considering a change in staff scheduling methods to increase continuity of care. Which scheduling/staffing type best promotes continuity of care?

Postpartum glycemic management in a client with an HbA1C of 11.4 % requires a complex carbohydrate approach to prevent rapid postprandial glucose spikes. Diet therapy focuses on low-glycemic index foods that provide sustained energy and satiety while minimizing the need for large doses of supplemental regular insulin in the immediate recovery period.

Rationale:

• Scrambled eggs provides a high-quality source of protein and fat with negligible carbohydrate content, making it an ideal postpartum breakfast option for a diabetic client. Protein slows gastric emptying, which helps stabilize blood glucose levels and prevents the acute hyperglycemia seen in the client’s 2250 glucose result of 278 mg/dL. Choosing eggs helps maintain a consistent carbohydrate intake as prescribed in the provider's orders.
• Selecting whole grains over refined options ensures a higher intake of dietary fiber, which significantly slows the absorption of glucose into the bloodstream. Fiber is essential for postpartum clients to prevent constipation, especially those with sluggish lower bowel sounds and a history of magnesium use. This selection supports the medium carbohydrate diet goal while providing necessary micronutrients for maternal recovery.
• Blueberry muffins are typically high in refined flour and added sugars, leading to a rapid increase in blood sugar levels. Even if they contain fruit, the high carbohydrate density and low fiber-to-sugar ratio make them unsuitable for a client already exhibiting signs of hyperglycemia like polydipsia and blurry vision. This choice would likely exacerbate the client’s metabolic instability.
• Waffles are primarily composed of simple carbohydrates and are often served with high-sugar syrups or toppings. For a client with poorly controlled gestational diabetes, consuming waffles would cause a significant glycemic excursion that could necessitate increased insulin titration. They lack the protein and fiber necessary to support stable blood sugar levels in the fourth stage of labor.
• While toast provides carbohydrates, the addition of jam introduces concentrated sweets that are quickly absorbed, leading to a sharp rise in serum glucose. The combination of white bread and jam represents a high-glycemic meal that contradicts the goal of managing the client’s 278 mg/dL glucose level. The nurse should emphasize complex alternatives to avoid further osmotic diuresis and polyuria.

Tetralogy of Fallot is a congenital cardiac defect characterized by pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. This combination results in a right-to-left shunt, leading to significant hypoxemia during exertion or crying, known as a tet spell. Squatting is a compensatory mechanism used by the child to increase systemic vascular resistance and improve pulmonary blood flow.

Rationale:

A. Forcing the child to stand would decrease systemic vascular resistance and exacerbate the hypoxic episode. Squatting is a natural instinct that helps force more blood into the pulmonary artery by kinking the femoral arteries. The nurse should never interfere with this protective and autonomic maneuver.

B. Intubation is an invasive, last-resort measure and is not indicated for a child who is actively compensating through squatting behavior. Most hypercyanotic spells are managed with knee-chest positioning, supplemental oxygen, and calming techniques. Immediate surgical or mechanical airway intervention is premature without assessing the severity of the spell.

C. The nurse must first determine the severity of the hypoxic event by checking the pulse oximetry. Assessing the oxygen saturation provides a baseline measurement to evaluate the effectiveness of the child’s squatting and determine if further oxygen therapy is needed. It is the priority assessment for cyanotic heart disease.

D. The Trendelenburg position is used for shock but is inappropriate and potentially harmful for a child in a tet spell. Instead, the nurse should facilitate the knee-chest position if the child stops squatting voluntarily. Proper positioning aims to reduce the right-to-left shunt and improve arterial oxygenation.