A nurse is planning care immediately following birth for a newborn who has a myelomeningocele that is leaking cerebrospinal fluid. Which of the following actions should the nurse include in the plan of care?

Explanation

Choice A Reason:

Polyuria, or excessive urination, is not a common adverse effect of opioid analgesics administered via epidural block. Opioids more commonly cause urinary retention rather than polyuria.

Choice B Reason:

Hypotension, or low blood pressure, is a potential adverse effect of opioid analgesics administered via epidural block. Opioids can cause vasodilation and decreased systemic vascular resistance, leading to hypotension, particularly when administered rapidly or in high doses.

Choice C Reason:

Bilateral crackles in the lungs are not typically associated with opioid analgesics administered via epidural block. They may indicate pulmonary congestion or fluid overload, which are not direct adverse effects of opioids.

Choice D Reason:

Hyperglycemia, or high blood sugar levels, is not a common adverse effect of opioid analgesics administered via epidural block. Opioids may affect glucose metabolism indirectly through their effects on the hypothalamic-pituitary-adrenal axis, but hyperglycemia is not a direct effect observed immediately following administration.

Explanation

A.When teaching parents about the Plastibell circumcision technique, it's important to explain that a yellow exudate (sometimes referred to as granulation tissue) will typically form at the surgical site within 24 hours after the procedure. This is a normal part of the healing process and should not be a cause for concern.

B.The end of the penis will likely get red, then develop a yellow discharge, and finally scab over, “like a skinned knee.” This is the normal healing process and will progress over the 7-14 days that the Plastibell Ring stays on. The correct size Plastibell Ring is secured with a string and the excess skin trimmed. The skin that overlaps the ring will turn dark “like the umbilical cord” before the ring falls off at 7-14 days.

C. Make sure the newborn's diaper is snug." This is inappropriate. Ensuring that the newborn's diaper is snug is not specific to the Plausible circumcision technique. Regardless of the circumcision method used, parents should be instructed to apply diapers comfortably, avoiding excessive tightness that may cause discomfort or compromise circulation to the area.

D. "The Plastibell will be removed 4 hours after the procedure." This is inappropriate. The Plausible device is typically left in place for several days until the residual foreskin dries up and falls off naturally. The exact timing of Plausible removal depends on the healthcare provider's instructions and the healing progress of the circumcision site. Removal usually occurs within 5 to 10 days after the procedure, not 4 hours.