A nurse is caring for a newborn who is 22 hr old. Which of the following findings should the nurse report to the provider?

• Rh (D) immune globulin. This medication is given to Rh-negative clients to prevent Rh sensitization. Since the client is O+ (Rh-positive), there is no risk of Rh incompatibility, making this medication unnecessary.
• Ibuprofen. This NSAID is prescribed for postpartum pain management. It is not contraindicated for this client, as her medical history and current condition do not interfere with its use.
• Doxycycline. This antibiotic is used to treat mastitis, and there is no reason to clarify its use for this client. Mild tachycardia (HR 102/min) is common postpartum and does not affect doxycycline administration.
• Bisacodyl. This stool softener is used to prevent postpartum constipation. There is no need to clarify its use, as it is safe and appropriate for the client.
• Of the client's blood type. Rh (D) immune globulin is only needed for Rh-negative clients. Since this client is Rh-positive (O+), administration is not required and should be clarified with the provider.
• Of the client's WBC count. The WBC count is 9,500/mm³, which is within the normal range (5,000 to 10,000/mm³). This does not indicate infection or any issue that would require clarification of medication administration.
• Of the client's heart rate. The client’s HR of 102/min is slightly elevated but within expected postpartum changes. This does not affect the safety of prescribed medications, so no clarification is needed.

A. Provide additional hydration by offering glucose water. Glucose water is not recommended for hydration or bilirubin elimination. Breast milk or formula should be the primary source of nutrition, as frequent feeding promotes stooling, which helps remove bilirubin from the body. Supplementing with glucose water can interfere with proper nutrition and milk intake.
B. Apply a water-based lotion to the newborn's skin every 4 hr. Lotion should not be applied to the newborn’s skin during phototherapy, as it can increase the risk of burns due to heat absorption from the phototherapy lights. Instead, keeping the skin clean and dry is essential to prevent irritation.
C. Monitor the newborn's heart rate every 2 hr. While vital signs should be monitored regularly, phototherapy primarily affects skin exposure, hydration, and bilirubin levels rather than cardiac function. The priority during phototherapy is monitoring temperature, hydration status, and bilirubin levels rather than frequent heart rate assessments.
D. Remove the newborn from phototherapy every 2 hr for breastfeeding. Frequent breastfeeding helps enhance bilirubin excretion through stooling and supports hydration. Short breaks from phototherapy for feeding are recommended to ensure adequate nutrition while maintaining effective bilirubin reduction. The newborn should be placed back under the lights as soon as feeding is completed.