The nurse is preparing to discharge a mother/baby couplet from the maternity unit. Which action by the parents requires further teaching?

Choice A reason: Anencephaly is a severe neural tube defect where a major portion of the brain, skull, and scalp is missing. It does not present with a tuft of hair on the lumbosacral area.

Choice B reason: Spina bifida, specifically spina bifida occulta, is associated with a small tuft of hair on the lumbosacral area. This condition involves a defect in the spinal column where the bones do not close completely, but the spinal cord and nerves are usually not affected.

Choice C reason: Meningocele is a type of spina bifida where the protective membranes (meninges) protrude through an opening in the spine, forming a sac filled with cerebrospinal fluid. While it involves a spinal defect, it does not typically present with a tuft of hair.

Choice D reason: Myelomeningocele is the most severe form of spina bifida where the spinal cord and nerves protrude through an opening in the spine. This condition often results in more significant neurological deficits and is not specifically associated with a tuft of hair on the lumbosacral area.

Choice A reason: Administering immune globulin as soon as possible after delivery is a correct step but does not include the critical combination of both immune globulin and the hepatitis B vaccine, which provides optimal protection for the newborn against hepatitis B.

Choice B reason: The combination of hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of birth is the most effective intervention for preventing hepatitis B transmission from the parent to the infant. This approach ensures immediate passive immunity through the immune globulin and active immunity through the vaccine, significantly reducing the risk of the newborn developing hepatitis B.

Choice C reason: Administering hepatitis B immune globulin within 20 hours after birth delays the initiation of protective measures compared to the 12-hour window. It is essential to provide both immune globulin and the vaccine as early as possible to maximize the protective effect against hepatitis B.

Choice D reason: Administering the hepatitis B vaccine 24 hours after birth is too late for immediate protection against the virus. The combination of immune globulin and vaccine should be provided within the first 12 hours to ensure the highest level of protection for the newborn. Delaying the vaccination could increase the risk of hepatitis B transmission and infection.