A nurse is caring for a client who is postpartum and has a prescription for Rho (D) Immunoglobulin. The nurse should verify which of the following prior to administration?

A) Hypocalcemia:

While newborns of diabetic mothers are at risk for various metabolic imbalances, such as hypocalcemia due to maternal hyperglycemia and subsequent fetal hyperinsulinemia, hypoglycemia is a more immediate concern. Hypocalcemia typically presents later and is managed through interventions such as calcium supplementation if necessary.

B) Hypoglycemia:

Newborns born to mothers with diabetes, especially those with macrosomia (large birth weight), are at increased risk of hypoglycemia due to fetal hyperinsulinemia and subsequent adaptation to the high glucose environment in utero. Monitoring and maintaining adequate blood glucose levels are crucial to prevent complications associated with hypoglycemia, making it the priority focus of care.

C) Hypomagnesemia:

While magnesium levels may be affected in newborns of diabetic mothers, hypomagnesemia is not typically the primary concern compared to hypoglycemia. Hypomagnesemia may occur but is generally less common and presents with different clinical manifestations compared to hypoglycemia.

D) Hyperbilirubinemia:

Hyperbilirubinemia, or jaundice, is a common concern in newborns, especially those born to mothers with diabetes. However, it is usually managed with phototherapy and monitoring of bilirubin levels, and severe complications are less immediate compared to hypoglycemia. Therefore, it is not the priority focus of care in this scenario.

A) Fundal height below the umbilicus:

In the immediate postpartum period, the fundus typically descends at a predictable rate. A fundal height below the umbilicus on the first day postpartum is expected. It is not a cause for immediate intervention unless accompanied by other signs of postpartum hemorrhage.

B) Decreased urge to void:

A decreased urge to void is common in the immediate postpartum period due to perineal swelling, episiotomy or lacerations, and the effects of regional anesthesia. However, it is not an immediate concern as long as the client is voiding adequate amounts of urine.

C) Increased urine output:

Increased urine output in the postpartum period is expected due to the diuretic effect of the body eliminating excess fluid retained during pregnancy. It is not a cause for immediate intervention as long as the client is not exhibiting signs of dehydration.

D) Displaced fundus from the midline:

A displaced fundus from the midline is concerning as it may indicate uterine atony, which is the most common cause of postpartum hemorrhage. Immediate intervention is necessary to prevent further complications such as excessive bleeding.