Which of the following interventions should a nurse include in the plan of care for a newborn who is to undergo a circumcision using a plastic bell device?

Choice A reason: Discussing pregnancy loss with others who have experienced it provides emotional support, reducing feelings of isolation. Grief triggers stress hormones like cortisol, which can affect mental health. Peer support normalizes emotional responses, aiding psychological recovery by fostering shared understanding and coping strategies, validated by psychosocial research in miscarriage care.

Choice B reason: Advising against seeing fetal remains is inappropriate, as it may dismiss the client’s emotional needs. Grief processing varies, and viewing remains can aid closure for some. This statement imposes a personal bias, ignoring individual psychological responses to loss, which are influenced by complex neuroendocrine and emotional pathways.

Choice C reason: While acknowledging grief is valid, stating it is okay “even though” it is early minimizes the loss’s impact. Early pregnancy loss can trigger significant grief due to hormonal shifts and attachment. This statement risks invalidating the client’s emotional experience, which is shaped by psychological and neuroendocrine responses to miscarriage.

Choice D reason: Determining the cause of a missed abortion at 10 weeks is often not feasible, as fetal tissue may not yield specific findings. Chromosomal abnormalities, a common cause, require genetic testing, not routine post-procedure analysis. This statement risks false reassurance, as miscarriage etiology is frequently multifactorial and not always identifiable.

Choice A reason: Early decelerations of the FHR result from head compression during contractions, a benign response reflecting vagal stimulation. They mirror contraction patterns and do not indicate fetal distress. Epidural analgesia may reduce maternal blood pressure, but early decelerations are unrelated to hypoxia, requiring no immediate reporting in this context.

Choice B reason: FHR accelerations of 15 beats/min for 15 seconds indicate fetal well-being, reflecting a responsive autonomic nervous system. They occur with fetal movement or stimulation and are not concerning. Epidural analgesia does not typically cause accelerations, and these findings do not warrant reporting, as they signify normal fetal oxygenation and neurological function.

Choice C reason: An FHR of 150/min is within the normal range (110-160/min) and does not indicate distress. Epidural analgesia may cause maternal hypotension, affecting placental perfusion, but a stable FHR within normal limits reflects adequate fetal oxygenation. This finding does not require immediate reporting, as it aligns with normal fetal physiology.

Choice D reason: Prolonged absent FHR variability suggests fetal compromise, as variability reflects autonomic nervous system function and oxygenation. Epidural analgesia can cause maternal hypotension, reducing placental perfusion and leading to hypoxia, which diminishes variability. This critical finding requires immediate reporting to address potential fetal distress and prevent adverse outcomes like acidosis.