The nurse is planning care for a newborn receiving phototherapy. Which interventions would be included in the plan of care? Select all that apply.

Choice A rationale Phototherapy generates heat, which can increase the neonate's core body temperature, leading to hyperthermia and increased insensible fluid loss. Close monitoring of the body temperature, typically every two to four hours, is necessary to maintain the neonate in a stable thermal state (normal range 97.7°F to 99.5°F or 36.5°C to 37.5°C) and prevent complications. Choice B rationale The high-intensity light used in phototherapy can cause retinal damage, potentially leading to irreversible vision impairment. Opaque eye shields must be correctly sized and placed to cover the infant's eyes completely while ensuring they do not obstruct the nares or cause pressure on the eyelids, which is essential for safety. Choice C rationale The efficacy of phototherapy depends on the maximum possible surface area of the skin being exposed to the light, as bilirubin absorbs the light and is converted into a water-soluble isomer for excretion. Therefore, only a diaper should be worn, maximizing skin exposure to facilitate bilirubin degradation and enhance treatment effectiveness. Choice D rationale Phototherapy increases insensible water loss through the skin and stool output due to the photo-oxidation products being excreted. Monitoring input (formula, breast milk) and output (urine, stools) every four hours is crucial to assess for and prevent dehydration, ensuring adequate hydration and promoting bilirubin excretion. Choice E rationale The quantity of one ounce of formula every two hours may not be sufficient or necessary for all newborns. Feeding should be based on the newborn's weight, caloric needs, and feeding status, typically promoting effective oral intake of breast milk or formula to enhance hydration and gastrointestinal motility for bilirubin excretion. Choice F rationale Supplementing formula before each breastfeeding session is strongly discouraged as a routine practice. This can decrease the infant's interest in the breast, interfere with successful latching, and negatively impact the mother's milk supply by reducing suckling stimulation, undermining the efforts to establish exclusive breastfeeding.