A nurse is caring for a newborn 4 hr after birth. Which of the following actions should the nurse include in the plan of care to prevent jaundice?

C) Massage the client's fundus to promote contractions:

Given the client's symptoms of excessive bleeding (soaked perineal pad in 10 minutes) and signs of hypovolemia (pale skin color, feeling weak, and light-headedness), massaging the client's fundus to promote contractions is the priority action. This intervention helps stimulate uterine contractions, which can aid in controlling postpartum hemorrhage by reducing uterine atony, a common cause of excessive bleeding after childbirth.

A) Administer oxytocin by continuous IV infusion:

While administering oxytocin by continuous IV infusion is a crucial intervention to promote uterine contractions and control bleeding in postpartum hemorrhage, massaging the fundus is the initial action to stimulate contractions directly. Oxytocin administration can follow fundal massage if the bleeding persists or worsens.

B) Tilt the client onto her right side with her legs elevated to at least 30°:

Positioning the client on her right side with legs elevated can improve venous return and cardiac output, but it is not the priority action in this scenario. Immediate treatment to address the potential cause of postpartum hemorrhage takes precedence over positioning adjustments.

D) Insert an indwelling urinary catheter:

Inserting a urinary catheter may be necessary to monitor urinary output and assess for bladder distention, especially if the client's fluid status needs close monitoring. However, it is not the priority action in this scenario, where addressing postpartum hemorrhage is the immediate concern

B) Vastus lateralis:

This is the correct site for administering IM injections to newborns, including vitamin K. The vastus lateralis muscle, located in the anterolateral aspect of the thigh, is the preferred site for IM injections in infants because it is well-developed, has few major blood vessels and nerves, and provides good absorption of the medication. It is recommended to divide the thigh into thirds and administer the injection in the middle third.

A) Ventrogluteal:

While the ventrogluteal site is commonly used for IM injections in adults and older children, it is not typically recommended for newborns due to the size of the muscle and potential risk of injury to underlying structures.

C) Dorsogluteal:

The dorsogluteal site is not recommended for IM injections in newborns due to the risk of injury to the sciatic nerve and other deep structures in the gluteal region.

D) Deltoid:

The deltoid muscle is not typically used for IM injections in newborns due to its smaller size and less-developed muscle mass compared to the vastus lateralis. It is more commonly used in older children and adults for certain vaccines and medications.