Question

While assessing an Rh positive newborn whose mother is Rh negative, the nurse recognizes the risk for hyperbilirubinemia. Which of the following should be reported immediately?

A) Jaundice evident at 26 hours
B) Hematocrit of 55%
C) Serum bilirubin of 12mg
D) Positive Coomb's test

Answer 1

Jaundice evident at 26 hours in an Rh positive newborn whose mother is Rh negative should be reported immediately as it suggests severe hemolytic disease such as HDN, due to Rh factor incompatibility.

Step-by-step explanation:

When assessing an Rh positive newborn whose mother is Rh negative, it is especially important to monitor for signs of hyperbilirubinemia, a condition characterized by high levels of bilirubin in the blood, which can cause jaundice and, in severe cases, kernicterus. Among the options provided, jaundice evident at 26 hours would be most concerning and should be reported immediately. This is because jaundice presenting within the first 24 hours of life is often indicative of severe hemolytic disease, such as hemolytic disease of the newborn (HDN), due to Rh factor incompatibility. A positive Coomb's test would confirm the presence of maternal antibodies against fetal red blood cells, which could lead to hemolysis and the subsequent jaundice. A hematocrit of 55% may signify polycythemia but is not as immediately concerning as early onset jaundice, while a serum bilirubin of 12 mg/dL may be concerning depending on the newborn's age in hours and the time-specific bilirubin chart being used.