A nurse is contributing to the plan of care for a newborn who has hyperbilirubinemia and is receiving phototherapy. Which of the following interventions should the nurse include?

Neonatal hyperbilirubinemia occurs when there is an excess buildup of bilirubin due to increased red blood cell breakdown and immature liver conjugation. Phototherapy is used to convert bilirubin into water-soluble isomers that can be excreted through urine and stool. Effective treatment requires maximizing skin exposure to light and ensuring even distribution of phototherapy. Nursing care focuses on hydration, thermoregulation, eye protection, and frequent repositioning. Rationale: A. Applying lotion to the newborn’s skin every 2 hours is contraindicated during phototherapy because it can increase skin absorption of heat and potentially interfere with light penetration. Lotions and oils may also cause overheating or skin irritation when exposed to phototherapy lights. Skin should remain clean and dry to allow effective bilirubin breakdown. B. Obtaining a blood glucose level every 4 hours is not a routine requirement for newborns receiving phototherapy unless there is a specific risk factor for hypoglycemia. Phototherapy primarily affects bilirubin metabolism and fluid balance rather than glucose regulation. Monitoring should focus on bilirubin levels, hydration status, and temperature. C. Repositioning the newborn every 2 to 3 hours is appropriate because it ensures maximum skin exposure to phototherapy light. Changing the infant’s position helps expose different body surfaces, improving the effectiveness of bilirubin breakdown. This intervention also promotes even treatment and prevents pressure-related complications. D. Offering glucose water every 1 to 2 hours is not recommended because it can interfere with adequate nutritional intake and is not effective in treating hyperbilirubinemia. Breast milk or formula feeding is preferred to promote bowel movements and bilirubin excretion. Frequent feeding helps reduce enterohepatic circulation of bilirubin more effectively than glucose water.