A 5-year-old child presents to the emergency department with a stiff jaw, muscle spasms, and difficulty swallowing. The mother reports the child stepped on rusty nail 10 days ago. Which of the following is the priority nursing intervention?

A. The combination of weak arm movement, absent Moro reflex, and intact grasp reflex directly points to an upper brachial plexus injury, consistent with Erb’s palsy. Immediate management includes supportive care, gentle range-of-motion exercises, and referral to a pediatric neurologist or physical therapist. Early intervention improves functional outcomes and reduces long-term disability.

B. Caput succedaneum is diffuse edema of the scalp caused by pressure during delivery, often crossing suture lines. It is benign, self-limiting, and does not affect limb movement or reflexes. The infant’s motor deficits are not explained by caput succedaneum.

C. Cephalohematoma is a localized subperiosteal blood collection, typically limited by suture lines. It presents as a firm scalp swelling, sometimes with jaundice as a complication. Cephalohematoma does not cause limb weakness or absent reflexes, so it is inconsistent with the findings in this case.

D. Facial nerve injury during birth, often due to traction or forceps application on the face, manifests as facial asymmetry, inability to close the eyelid, drooping of the mouth, or absent nasolabial fold. It does not affect arm movement or the Moro reflex, so it cannot account for the infant’s symptoms.

A. Hypoglycemia in newborns is generally caused by maternal diabetes, preterm birth, intrauterine growth restriction, or perinatal stress. It occurs because the newborn produces excess insulin or has limited glycogen stores. Rh sensitization does not affect glucose metabolism, so neonatal hypoglycemia is unrelated to maternal Rh status.

B. If an Rh-negative mother becomes sensitized after delivering an Rh-positive infant without receiving Rho(D) immune globulin, she can form anti-Rh antibodies. In a future pregnancy with an Rh-positive fetus, these antibodies can cross the placenta and destroy fetal red blood cells, causing hemolytic disease of the newborn (HDN). Severe HDN may lead to fetal anemia, hydrops fetalis, or miscarriage/stillbirth if left untreated.

C. Macrosomia, defined as birth weight >4,000–4,500 g, is typically associated with maternal diabetes, maternal obesity, or genetic predisposition. Rh incompatibility does not influence fetal growth or increase the risk of macrosomia, so it is not a concern in sensitized mothers.

D. Placenta previa occurs when the placenta partially or completely covers the cervical os, which can cause bleeding during pregnancy. Its risk factors include previous cesarean delivery, uterine surgery, multiple gestations, or advanced maternal age, but Rh sensitization has no effect on placental location, so it is unrelated.