The practical nurse (PN) is reinforcing the instructions to the parents of a child who had a surgical repair of a myelomeningocele about changing an occlusive dressing on the child's back.
Which statement by the parents indicates that they understand this procedure?

Choice A rationale

Deep tendon reflexes are neurological assessments primarily used to evaluate neuromuscular excitability, particularly in conditions like preeclampsia where magnesium sulfate is administered. They are not indicated for managing fetal heart rate decelerations or chorioamnionitis, as these conditions do not directly impact spinal reflex arcs or necessitate this specific neurological monitoring. Normal reflexes range from 1+ to 2+.

Choice B rationale

Late decelerations, occurring after the peak of a contraction, indicate uteroplacental insufficiency, meaning reduced blood flow and oxygen to the fetus. A left side-lying position alleviates compression of the vena cava and aorta by the gravid uterus, thereby increasing venous return to the heart and improving uterine perfusion and oxygenation to the fetus, which is a crucial intervention.

Choice C rationale

Insertion of an indwelling urinary catheter to monitor hourly output is primarily indicated for assessing renal perfusion and fluid balance, particularly in critically ill clients or those at risk for fluid volume alterations, such as severe preeclampsia. It does not directly address or correct the underlying physiological cause of late fetal heart rate decelerations. Normal urine output is typically greater than 30 mL/hour.

Choice D rationale

Collecting a urine specimen for electrolytes and protein is a diagnostic measure for evaluating renal function, hydration status, and potential complications like preeclampsia, which presents with proteinuria. While important for overall assessment, it does not provide an immediate physiological intervention to improve uteroplacental perfusion and resolve acute fetal distress manifested by late decelerations.

Choice A rationale

Administering ibuprofen, an NSAID, can alleviate pain by inhibiting prostaglandin synthesis, reducing inflammation. However, increased pain and pressure postpartum, especially with a laceration, could indicate complications like a hematoma. Normal pain is expected, but increasing pain warrants further assessment, as it could mask a worsening condition and delay necessary intervention.

Choice B rationale

Increased pain and pressure postpartum after a vaginal delivery, especially with a second-degree perineal laceration, could signal a perineal hematoma. This condition involves blood accumulation in the tissue, causing significant pain and pressure. Notifying the healthcare provider is crucial for immediate assessment, diagnosis, and potential intervention to prevent further complications.

Choice C rationale

Applying an ice pack to the perineum is a common intervention for pain and swelling after a vaginal delivery and laceration repair. Cold therapy induces vasoconstriction, which reduces blood flow to the area, thereby minimizing edema and inflammation. This can provide localized pain relief, but for increasing pain, it might only offer symptomatic relief without addressing the underlying cause.

Choice D rationale

Routine perineal care, including cleansing and hygiene, is essential for preventing infection and promoting healing after a vaginal delivery and laceration. It helps remove lochia and bacteria, maintaining a clean environment. While crucial for recovery, routine care does not directly address or alleviate increasing pain and pressure that could indicate a complication like a hematoma.