A nurse is caring for a newborn who was born at 39 weeks of gestation and is 36 hours old.

Exhibits

Which of the following findings should the nurse report to the provider? Select all that apply.

Myelomeningocele is the most severe type of spina bifida, a birth defect in which the spinal cord and its protective covering (meninges) protrude outside the body through an opening in the spine. This can cause nerve damage, muscle weakness, bladder and bowel dysfunction, and/or paralysis. Myelomeningocele requires surgical treatment after birth to repair the opening in the spine and prevent infections and further complications. According to the Mayo Clinic, the following actions should be included in the plan of care for a newborn who has a myelomeningocele that is leaking cerebrospinal fluid:

Cover the sac with a sterile, moist dressing to prevent it from drying out and becoming infected.
Place the baby in a prone position (on the stomach) or on the side to avoid putting pressure on the sac.
Monitor the vital signs, especially the temperature, as the baby may have difficulty regulating body temperature.
Administer antibiotics as prescribed to prevent meningitis and other infections.
Prepare for surgical closure of the sac within the first 24 to 48 hours after birth.
Therefore, the correct answer to your question is d. Administer broad-spectrum antibiotics. The other options are not appropriate for the immediate postnatal care of a newborn with myelomeningocele. Preparing for surgical closure after 72 hours is too late, as the risk of infection and complications increases with time. Monitoring the rectal temperature every 4 hours is not enough, as the baby may need more frequent checks and interventions to maintain a normal body temperature. Cleansing the site with povidone-iodine is not recommended, as it may irritate the delicate tissues and cause more harm than good

Choice A rationale:
A 21-gauge needle is too large for a heel stick on a newborn.
Choice B rationale:
Alcohol can cause skin irritation and should not be used after the procedure.
Choice C rationale:
A warm cloth, not a cool one, should be applied to the site before the procedure to enhance circulation.
Choice D rationale:
The lateral side of the heel is the correct site for a heel stick to avoid injury to the bone.