A multigravida at 41-weeks gestation is receiving an oxytocin (Pitocin) infusion for induction of labor.

The nurse notes the fetal heart rate (FHR) drops sharply from the baseline for 30 seconds during the peak of a contraction and then returns to the baseline before the end of the contraction.

What action should the nurse implement at this time?

The newborn’s skin color is pink.This indicates that the phototherapy is effective in lowering the serum bilirubin level by transforming it into water-soluble isomers that can be eliminated without liver conjugation.

A pink skin color also means that the newborn is not jaundiced, which is a sign of high bilirubin levels.

Choice B is wrong because clay-colored stools indicate a problem with the liver or bile ducts.Bile is needed to give stools their normal brown color, and if bile is absent or blocked, the stools may become pale or clay-colored.This could be a sign of a serious condition such as biliary atresia, which is a congenital defect that causes bile ducts to be absent or malformed.

Choice C is wrong because a bilirubin level of 12 mg/dL is still high for a newborn and may require further treatment.The American Academy of Pediatrics recommends phototherapy for newborns with bilirubin levels above 15 mg/dL at 25 to 48 hours of age, 18 mg/dL at 49 to 72 hours of age, and 20 mg/dL at more than 72 hours of age.However, these thresholds may vary depending on the gestational age, risk factors, and clinical condition of the newborn.

Choice D is wrong because dark yellow urine may indicate dehydration or concentrated urine, which can increase the risk of bilirubin toxicity.Newborns receiving phototherapy should be well hydrated and have frequent wet diapers to help eliminate bilirubin from the body.Normal urine color for a newborn is pale yellow or clear.

Phototherapy is a treatment that uses light to break down bilirubin in the blood and make it easier for the liver to eliminate it.

Phototherapy is effective when:

• The bilirubin levels decrease within 24 hours of treatment.

This means that the bilirubin is being cleared faster than it is being produced.

• The urine output and stool frequency increase during treatment.

This means that the bilirubin is being excreted through the kidneys and intestines.

• The skin color and muscle tone improve after treatment.

This means that the bilirubin is no longer causing jaundice or affecting the nervous system.

Statement A is wrong because it only describes one aspect of phototherapy effectiveness.

Statement B is wrong because it only describes another aspect of phototherapy effectiveness.

Statement C is wrong because it only describes the outcome of phototherapy effectiveness.

Statement D is correct because it includes all three aspects of phototherapy effectiveness.