A nurse is caring for a client who is 6 hours postpartum. The client is Rh-negative and her newborn is Rh-positive. The client asks why an indirect Coombs test was ordered by the provider. Which of the following is an appropriate response by the nurse?

Choice A reason:
Tipping the nipple to allow air as the baby sucks can lead to the baby ingesting air, which may cause discomfort and increase the risk of colic. Proper bottle feeding technique involves tilting the bottle to fill the nipple with milk, thus preventing the baby from swallowing air.

Choice B reason:
Keeping the baby's head elevated during feeding is recommended to prevent milk from flowing too fast and to reduce the risk of ear infections and choking. It also aids in proper digestion and helps prevent reflux.

Choice C reason:
Allowing the baby to burp several times during each feeding is important to release any air swallowed during feeding. This can help prevent discomfort, gas, and spit-up. Burping can be done by gently patting the baby's back in different positions such as over the shoulder, sitting up, or lying across the lap.

Choice D reason:
Expecting soft, formed yellow stools is appropriate for a newborn, especially if breastfed, as their stools tend to be soft and a mustard yellow color. The frequency and consistency of stools can vary, but they generally reflect the baby's diet and are an indicator of good health.

Choice A reason:
Administering oxygen using a non-rebreather mask is a subsequent step if initial measures do not improve fetal heart rate decelerations. It can help increase the amount of oxygen available to the fetus. Oxygen administration is a supportive measure that can be used if there are signs of fetal distress. In the scenario described, where the fetal heart rate slows after the start of a contraction with the lowest rate occurring after the peak, it suggests late decelerations, which are often associated with uteroplacental insufficiency. Administering oxygen can help increase the fetal oxygen reserve and is a common intervention during labor when there are concerns about fetal well-being.

Choice B reason:
Increasing the rate of maintenance IV infusion is typically considered when there is a concern for maternal hypotension or dehydration, which may not be the immediate cause of the observed fetal heart rate pattern. Increasing the rate of an IV infusion can help improve maternal hydration and blood pressure, which in turn can enhance placental perfusion. However, this intervention is more indirect and may not provide the immediate response needed to address fetal heart rate decelerations. It is typically considered after more direct interventions, such as repositioning the mother, have been attempted.

Choice C reason:
Elevating the client's legs can help improve venous return to the heart, potentially increasing maternal cardiac output and blood flow to the placenta. While this can be beneficial, it is not the primary intervention for late decelerations. Repositioning the mother to improve uteroplacental circulation is generally the first step.
Choice D reason:
Placing the client in the lateral position is often the first action taken when late decelerations are observed. This position helps improve uteroplacental blood flow and can quickly address potential issues related to fetal oxygenation. This position helps to relieve pressure on the inferior vena cava and aorta, which can be compressed by the gravid uterus, especially in the supine position. Relieving this pressure helps to improve uteroplacental circulation and can quickly address the cause of late decelerations, which is often related to compromised blood flow to the placenta.