A nurse is caring for a client who has named a person to serve as his health care proxy. The client talks about this type of advance directives. Which of the following statements by the client indicates a need for clarification?

A. Dry the skin: The priority nursing action immediately following birth is to ensure the newborn's warmth. Drying the newborn's skin helps prevent hypothermia, which is a significant risk for neonates. The nurse should dry the newborn's skin using a warm, dry towel to prevent heat loss through evaporation.
B. Administer vitamin K: Administering vitamin K is an important procedure shortly after birth to prevent hemorrhagic disease of the newborn. However, ensuring warmth by drying the skin takes precedence over administering vitamin K as the newborn's temperature regulation is crucial immediately after delivery.
C. Place an identification bracelet: Placing an identification bracelet on the newborn is essential for proper identification and security purposes, but it is not the priority immediately after birth. Ensuring the newborn's warmth and maintaining physiological stability take precedence.
D. Administer eye prophylaxis: Administering eye prophylaxis, typically in the form of erythromycin ointment or another antimicrobial agent, is important to prevent neonatal conjunctivitis due to exposure to maternal pathogens during delivery. However, this intervention can wait until after the newborn's warmth is ensured through drying the skin.

A. Notify the client's provider: This option might be considered if there are signs of postpartum hemorrhage, such as excessive bleeding, signs of shock, or a boggy uterus that does not respond to massage. However, in this scenario, the fundus is midline and firm, which indicates appropriate uterine contraction. Therefore, notifying the provider at this point may not be necessary.
B. Encourage the client to empty her bladder: Encouraging the client to empty her bladder is always important in the postpartum period, as a full bladder can impede uterine contraction. However, the presence of lochia rubra and small clots along with a midline and firm fundus suggests that uterine involution is progressing well. While encouraging the client to empty her bladder is appropriate, it may not be the priority in this situation.
C. Increase the frequency of fundal massage immediately: Fundal massage is typically performed to promote uterine involution and prevent postpartum hemorrhage. However, in this scenario, the fundus is already midline and firm, indicating adequate contraction. Increasing the frequency of fundal massage unnecessarily could cause discomfort to the client and is not indicated based on the current assessment findings.
D. Document the findings and continue to monitor the client: This is the most appropriate action at this time. The presence of lochia rubra and small clots along with a midline and firm fundus suggests that the uterus is involuting properly. Documenting the findings allows for accurate documentation of the client's condition and continued monitoring for any changes or developments. If the client's condition changes or if there are signs of postpartum hemorrhage, further action, such as notifying the provider, can be taken.