Rho immune globulin (Rhogam) will be ordered postpartum if which situation occurs?

A) Rubra, serosa, alba:
The normal progression of lochia, the vaginal discharge after childbirth, follows a predictable sequence of stages. Lochia rubra is the initial stage, occurring within the first few days postpartum. It is bright red and consists primarily of blood, tissue, and debris from the placenta. After 3-4 days, the discharge changes to lochia serosa, which is pinkish-brown and contains a mixture of blood, serous fluid, and mucous. After 10-14 days, it progresses to lochia alba, which is white or pale yellow and consists mostly of leukocytes (white blood cells), mucus, and epithelial cells. This is the expected progression, which marks the natural healing process after childbirth.

B) Rubra, alba, serosa:
This order is incorrect because lochia serosa comes before lochia alba in the normal sequence. Lochia alba occurs after lochia serosa, not before. This progression would not accurately reflect the typical stages of lochia.

C) Serosa, alba, rubra:
This sequence is incorrect as lochia rubra is the first stage, not lochia serosa. The initial discharge following childbirth is always red and blood-tinged, which is lochia rubra. Serosa and alba come later in the progression, so this order does not follow the correct timeline.

D) Alba, rubra, serosa:
This order is completely incorrect. Lochia rubra (red blood discharge) is the first stage, not lochia alba (white discharge). After childbirth, rubra occurs first, followed by serosa, and then finally alba. This sequence does not reflect the normal postpartum discharge process.

A) "Babies usually breathe in and out through their noses so they can feed without choking.":
Newborns are obligate nasal breathers, meaning they primarily breathe through their noses rather than their mouths, which helps coordinate breathing with feeding. This nasal breathing mechanism helps prevent aspiration and ensures that babies can feed while still breathing. It is perfectly normal for a baby to primarily use their nose for breathing, especially in the early days of life, and no cause for concern should be raised about small nasal openings unless the baby is showing signs of respiratory distress.

B) "You are right. I will report the baby's small nasal openings to the pediatrician right away.":
A small nasal opening is common in newborns and is not usually a cause for alarm unless it interferes with breathing, feeding, or shows signs of a more significant anatomical issue. There is no immediate need to report it unless the baby is having trouble breathing or feeding. The nurse should offer reassurance instead.

C) "Everything about babies is small. It truly is amazing how everything works so well.":
While this response may seem comforting, it is not very informative. It dismisses the mother’s concern rather than providing a clear and educational explanation. Reassuring the mother with factual information about why babies breathe through their noses and how this works effectively for them would be more helpful.

D) "The baby does rarely open his mouth but you can see that he isn't in any distress.":
This response minimizes the importance of the mother’s question and doesn’t fully address her concern. While it’s true that babies rarely open their mouths to breathe, the explanation needs to focus on the physiological reasoning behind it. The nurse should also reassure the mother that nasal breathing is normal in newborns and not typically a concern unless signs of distress are present.