Your patient just had her first baby two days ago. The infant is healthy and breastfeeding well. What are important things to teach her about the safety of her baby: (select all that apply)

A) Have the client void, then reassess the fundus:
A fundus that is firm but shifted to the right of the midline is a common sign of bladder distention. After childbirth, the bladder may fill with urine, which can displace the uterus and cause it to deviate from the midline, typically to the right. The first step in managing this situation is to have the client void to relieve the bladder distention, which often resolves the uterine shift. Once the bladder is empty, the nurse should reassess the fundus to see if the position returns to midline and remains firm. This is a non-invasive and effective initial intervention.

B) Encourage the client to ambulate:
Encouraging the client to ambulate could be beneficial for overall recovery, but it is not the priority action in this case. The issue at hand is a shifted fundus likely due to bladder distention, which should be addressed by encouraging the client to void first. Ambulation can be considered later when the immediate concern of bladder distention is managed.

C) Notify the healthcare provider:
While notifying the healthcare provider may be necessary if the issue persists after voiding or if there are other signs of complications, it is not the first step. The nurse should first attempt to resolve the issue through bladder emptying, as this is the most common cause of the shift in the fundus. If the problem persists after this, then further steps, including notifying the healthcare provider, would be appropriate.

D) Obtain an order for oxytocin:
Oxytocin is typically administered to help with uterine contraction and involution. However, since the fundus is firm and the primary issue appears to be bladder distention, administering oxytocin is not indicated at this time. The priority is to address the likely cause of the fundus being shifted, which is a full bladder. If the issue persists after voiding, then further intervention such as administering oxytocin may be considered.

A) Intracostal retractions:
Intracostal retractions indicate respiratory distress in the newborn and should be reported immediately to the neonatologist. Retractions occur when the muscles between the ribs (intercostal muscles) are drawn in with each breath, signifying increased effort to breathe. This could indicate a serious condition such as respiratory distress syndrome (RDS), pneumonia, or other respiratory compromise. This finding requires urgent assessment and potential intervention to ensure the neonate is receiving adequate oxygenation.

B) Caput succedaneum:
Caput succedaneum is a common and benign finding in newborns, especially after a vaginal delivery. It refers to a swelling of the soft tissue on the baby's head, often seen after prolonged labor or use of forceps during delivery. This condition is typically resolves on its own within a few days and does not require immediate intervention or reporting to the neonatologist.

C) Positive Babinski sign:
A positive Babinski sign (fanning of the toes when the sole is stroked) is a normal reflex in neonates and is expected up to about 2 years of age. It is part of the newborn's neurological development and indicates the functioning of the central nervous system. Therefore, this finding does not require reporting to the neonatologist.

D) Pink-tinged urine in the diaper:
Pink-tinged urine, also known as "brick dust" or uric acid crystals, is a common finding in the first few days of life. It is typically harmless and results from concentrated urine or from the breakdown of urates. It usually resolves as the newborn begins to consume more fluids and the urine becomes more diluted. This finding does not necessitate immediate reporting unless it persists or is associated with other symptoms.