The practical nurse (PN) is assisting with the care of an infant who was born 6 hours ago and is prescribed supplemental oxygen.
Which action can the PN safely implement?

Choice A rationale

Applying a cold pack to the perineum after a vaginal delivery effectively reduces localized edema and inflammation. Cold therapy causes vasoconstriction, which decreases blood flow to the area, thereby minimizing fluid extravasation into the interstitial spaces and reducing swelling of the episiotomy site.

Choice B rationale

While cold packs do provide a degree of comfort by numbing nerve endings and reducing pain signals, their primary physiological benefit in the postpartum period is the reduction of swelling and inflammation, which indirectly contributes to comfort. Comfort is a secondary effect.

Choice C rationale

The statement is incorrect. Cold therapy is a recognized and effective intervention postpartum. While it may help reduce bruising by limiting subcutaneous bleeding, its most significant and immediate benefit relates to the reduction of swelling and pain.

Choice D rationale

While cold can induce vasoconstriction and thus potentially reduce bleeding, it is not the primary or most effective method for controlling significant postpartum hemorrhage. Fundal massage and uterotonics are the primary interventions for controlling postpartum bleeding.

Choice A rationale

While wearing a supportive bra can manage symptoms like leaking, it does not address the underlying physiological changes or provide reassurance about their normalcy during pregnancy. The primary concern is to alleviate anxiety and provide accurate information, not just symptom management. Breast changes are common, and this choice does not prioritize assessment or explanation.

Choice B rationale

Rescheduling the appointment prematurely might cause unnecessary anxiety for the client if the symptoms are indeed normal. It disrupts the established prenatal care schedule without sufficient clinical indication. Unless acute distress or clear signs of pathology are present, waiting for the scheduled visit is generally appropriate.

Choice C rationale

During the third trimester, breast tissue undergoes significant hormonal changes in preparation for lactation, leading to increased vascularity, glandular growth, and sometimes the leakage of colostrum, a yellowish fluid. These are normal physiological adaptations, and reassuring the client while noting it for the upcoming visit provides appropriate, evidence-based care.

Choice D rationale

While darkened areolae are another common physiological change during pregnancy due to increased melanocyte-stimulating hormone, asking about it does not directly address the client's current concerns about "lumpy places" or fluid leakage. It's a related but separate observation, and the initial focus should be on explaining the normal changes the client is reporting.