A nurse is assisting with the care of a newborn who has a myelomeningocele. The nurse should ensure that which of the following supplies is available at the bedside?

Rationale:

• Insert a peripheral IV catheter: A peripheral IV catheter is essential for administering fluids and medications, which is critical for this adolescent, especially with the concern for bacterial meningitis.
• Place the adolescent on a cooling blanket: The adolescent has a high fever (39°C), which needs to be managed promptly to prevent further complications. A cooling blanket helps reduce the fever and manage the patient’s temperature.
• Administer IV acyclovir: Acyclovir is an antiviral medication typically used to treat viral infections such as herpes simplex virus or varicella-zoster virus, not bacterial meningitis. Given the CSF findings and suspected bacterial meningitis, acyclovir is not appropriate. Antibiotics like cefotaxime are indicated instead.
• Place on seizure precautions: Given the adolescent's symptoms (e.g., headache, photophobia, lethargy), the risk of seizures is elevated, especially if meningitis is suspected. Seizure precautions are important to prevent injury during a potential seizure.
• Keep adolescent flat in bed for 24 hr post lumbar puncture: After a lumbar puncture, keeping the adolescent flat in bed for 24 hours helps prevent post-lumbar puncture headaches and minimizes the risk of cerebrospinal fluid leaks or complications.
• Administer IV cefotaxime: IV cefotaxime is an appropriate antibiotic for treating bacterial meningitis. Given the abnormal CSF results (low glucose, high protein, elevated WBC), the adolescent is at high risk for bacterial meningitis, and IV cefotaxime is expected to be part of the treatment plan.

A. Latex gloves: Latex gloves should be avoided, especially in newborns, due to the risk of allergic reactions. Non-latex gloves are the preferred option for any care involving newborns.
B. Soft restraints: Soft restraints are not necessary for the care of a newborn with a myelomeningocele unless there is a specific concern for the infant’s safety. Restraints should not be routinely used unless deemed absolutely necessary.
C. Sterile saline: Sterile saline is essential for cleaning and maintaining the integrity of the myelomeningocele sac. The sac should be kept moist with sterile saline to prevent it from drying out or becoming infected. This is a critical to have at the bedside for proper care.
D. Rectal thermometer: A rectal thermometer should be avoided in infants with a myelomeningocele, especially if the sac involves the lower spinal cord, as it can potentially cause injury to the delicate tissue or result in a risk of infection.