A nurse is formulating a care plan for an infant diagnosed with spina bifida who is scheduled for a surgical closure of the myelomeningocele sac.

Which of the following interventions should be incorporated into the care plan?

Choice A rationale
Uterine atony refers to a soft and weak uterus after childbirth. It happens when your uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth. This can lead to life-threatening blood loss after delivery. One of the causes of uterine atony is urinary retention. When the bladder is full, it can displace the uterus, preventing it from contracting properly. This can lead to uterine atony and postpartum hemorrhage. Therefore, urinary retention can cause uterine atony and lateral displacement of the fundus.
Choice B rationale
Poor involution of the uterus is a condition where the uterus does not return to its normal size after childbirth. While poor involution can lead to prolonged bleeding, it does not directly cause uterine atony. Uterine atony is specifically a lack of muscle contraction, while poor involution is a failure of the uterus to reduce in size.
Choice C rationale
While infection can lead to many complications during the postpartum period, it is not a direct cause of uterine atony. Infections can cause endometritis, which is inflammation of the uterine lining, but this does not prevent the uterus from contracting.
Choice D rationale
Hemorrhage, or heavy bleeding, is a result of uterine atony, not a cause. When the uterus does not contract properly after childbirth, it can lead to excessive bleeding, or hemorrhage.

Choice A rationale
Keeping the head of the bed at a 30-degree angle is not typically necessary following scoliosis repair with Harrington rod instrumentation. The position of the bed is usually determined by the patient’s comfort and the surgeon’s specific post-operative instructions.
Choice B rationale
Initiating the use of a PCA (Patient-Controlled Analgesia) pump for pain control is a common intervention following scoliosis repair with Harrington rod instrumentation. This allows the patient to self-administer pain medication as needed, providing effective and individualized pain control.
Choice C rationale
Repositioning the client by log rolling every 4 hours is a common practice after spinal surgery to prevent pressure ulcers and maintain alignment of the spine. However, it is not the primary intervention in this case.
Choice D rationale
Placing the client in protective isolation is not typically necessary following scoliosis repair with Harrington rod instrumentation. Isolation is usually reserved for patients who are at high risk of infection or who have an infection that could be transmitted to others.