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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.

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.

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.

Involution is the process by which the uterus returns to its non-pregnant state, involving uterine contractions that decrease uterine size and minimize blood loss. Problems with involution, such as subinvolution, would typically present with prolonged lochial discharge and a boggy uterus, not primarily severe cramping immediately following breastfeeding.

An ileus is a temporary lack of normal muscle contractions in the intestines, leading to a build-up of food material. This condition would manifest as abdominal distension, absent bowel sounds, nausea, and vomiting. While possible post-delivery, it is not directly related to breastfeeding and would not typically cause severe cramping immediately after nursing.

A retained placenta refers to fragments of the placenta remaining in the uterus after delivery. This condition typically causes persistent postpartum bleeding, uterine atony, and a risk of infection. While it can cause uterine cramping due to the body's attempts to expel the tissue, the severe cramping immediately after breastfeeding is more directly related to hormonal release.

If the mother is Rh positive and the baby is Rh negative, there is no risk of Rh incompatibility. The Rh-positive mother's immune system will not produce antibodies against the Rh-negative fetal red blood cells, as she already possesses the Rh antigen. Therefore, Rho immune globulin is not indicated in this scenario, as there is no sensitization risk.

When both the mother and the baby are Rh negative, there is no Rh incompatibility. Since neither the mother nor the baby has the Rh antigen, the mother's immune system will not be stimulated to produce anti-Rh antibodies. Consequently, Rho immune globulin administration is unnecessary in this situation, as no immune response will be triggered.

The Rh status of the father is relevant in determining the potential for Rh incompatibility, but it does not directly dictate the need for Rho immune globulin. The critical factor is the Rh status of the mother and the baby. If the mother is Rh positive, regardless of the father's Rh status, she will not produce Rh antibodies, and RhoGAM is not indicated.

Sweet potatoes are a gluten-free root vegetable. They are rich in vitamins, minerals, and fiber, and their consumption is safe for individuals with celiac disease or gluten sensitivity. The presence of antigliadin and antiendomysial antibodies indicates a gluten-related disorder, necessitating avoidance of gluten-containing grains, not sweet potatoes.

Orange juice is a gluten-free beverage, primarily composed of water, sugars, and vitamins. It does not contain any gluten-derived proteins. Its consumption is safe for individuals with celiac disease or gluten sensitivity, as it will not elicit an immune response or contribute to intestinal damage in those with antigliadin and antiendomysial antibodies.

Swiss cheese is a dairy product and naturally gluten-free. It consists primarily of milk proteins, fats, and calcium, with no gluten-containing grains. Individuals with celiac disease or gluten sensitivity can safely consume Swiss cheese without triggering an immune response, as it does not contain the specific proteins that activate antigliadin and antiendomysial antibodies.

Routine prescription based solely on parity (number of previous pregnancies) is not standard medical practice. Methylergonovine is administered based on clinical indication, primarily to prevent or manage postpartum hemorrhage, which is determined by factors like uterine atony or excessive bleeding, not simply the number of previous births. Unnecessary administration can lead to adverse effects.

While methylergonovine does contract the uterus and prevent excess bleeding, this response is a general statement. The best response directly addresses the client's current situation and her question about why *she* is receiving it *this time*. It is crucial to explain the specific clinical reason for her individual prescription, which in this context is likely due to the increased bleeding.

This response shifts the responsibility back to the client and does not provide the requested information. It fails to address the client's direct question about the medication's purpose in her specific situation. Providing clear and concise information is essential for client education and adherence to the treatment plan.

Cheese is a good source of calcium and protein, but it is not a primary source of iron. Iron is essential for hemoglobin synthesis, and the client's hemoglobin and hematocrit levels are below normal ranges [Hemoglobin, pregnant female > 11 g/dL ( > 110 g/L); Hematocrit, pregnant female > 33% ( > 0.33 volume fraction)], indicating iron deficiency anemia.

Cauliflower is a cruciferous vegetable rich in vitamin C and fiber, but its iron content is relatively low. While vitamin C aids in iron absorption, cauliflower itself does not provide a significant amount of dietary iron to effectively address the client's anemic status.

Carrots are well-known for their beta-carotene content, a precursor to vitamin A, and provide fiber. However, carrots are not a significant source of iron. To combat iron deficiency anemia during pregnancy, foods rich in heme iron or non-heme iron with good bioavailability are required.

Sharing the observation with the charge nurse without first addressing the issue directly with the mother is not the most immediate or appropriate action. The PN should first attempt to educate and guide the mother, as this is within the scope of practice for direct client care and education.

Asking the mother if she is too tired is speculative and may be perceived as judgmental, potentially creating a barrier to effective communication and education. The PN's role is to provide health education and guidance regarding safe infant feeding practices, focusing on the behavior rather than the mother's perceived fatigue.

While observing the infant's behavior during feeding is important for a comprehensive assessment, the immediate and most critical action is to intervene with the unsafe practice of bottle propping. Observing further without addressing the identified risk delays necessary education and intervention to ensure infant safety.

Gravida 2 would inaccurately represent the total number of pregnancies. This calculation would exclude either the current pregnancy or one of the previous pregnancy losses, which contradicts the definition of gravida as the total count of all pregnancies.

Gravida 1 would be incorrect as it only counts the current pregnancy and completely disregards the two previous pregnancies, one ending in miscarriage and another in fetal demise. The term "gravida" encompasses all pregnancies, irrespective of outcome.

Gravida 3 would be incorrect as it would only account for the two previous pregnancies and the current one but would not include the miscarriage at 16-weeks gestation, which is still considered a pregnancy for gravida count. The current pregnancy is added to the total.

Vulvo-perineal tissues and episiotomy assessment is important to identify hematomas or excessive swelling. While significant, these are typically less life-threatening in the immediate postpartum period compared to uterine atony. Hematomas can cause pain and pressure, and wound integrity is vital for infection prevention.

Body temperature assessment is important to detect fever, which could indicate infection. Postpartum infection is a concern, but hypovolemic shock from hemorrhage is a more immediate and critical threat to maternal well-being. Normal postpartum temperature is typically below 38°C (100.4°F).

Breast engorgement and nipple integrity are important for promoting successful breastfeeding and preventing complications like mastitis. However, these are not immediate life-threatening concerns in the initial hours after delivery. Early assessment focuses on maternal physiological stability.