The nurse is performing a newborn assessment on a 37-week-gestation newborn at 2 hours of life. The nurse notes a small tuft of hair on the lumbosacral area of the spine. Which neural tube defect will the nurse associate with this assessment finding?

Choice A reason: Applying a cold pack to the affected area is the most appropriate intervention for managing hemarthrosis (bleeding into the joint) in a patient with haemophilia A. Cold therapy helps reduce pain, swelling, and inflammation by constricting blood vessels, which can slow down bleeding. This intervention also provides comfort to the patient and helps manage the acute symptoms of hemarthrosis effectively.

Choice B reason: Administering ibuprofen for pain is not recommended for patients with haemophilia A because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding by inhibiting platelet function. Instead, acetaminophen (Tylenol) is often preferred for pain management in these patients as it does not have the same blood-thinning effects.

Choice C reason: Performing range-of-motion exercises is not appropriate during the acute phase of hemarthrosis. Movement and exercise can exacerbate bleeding and increase pain. It is essential to allow the joint to rest and stabilize before considering gentle range-of-motion exercises during the recovery phase. Immediate management should focus on controlling bleeding and reducing inflammation.

Choice D reason: Placing the leg in a dependent position (lower than the heart) is not recommended for managing hemarthrosis. Elevating the affected limb is a better approach as it helps reduce swelling and pain by promoting venous return and minimizing blood flow to the affected area. The dependent position can increase blood flow to the joint, potentially worsening the bleeding and swelling.

Choice A reason: Oral suspension is not an appropriate method for administering botulinum toxin. This medication is not effective when taken orally and needs to be administered directly into the muscle to address spasticity.

Choice B reason: Intravenous infusion is also not the appropriate method for administering botulinum toxin. The medication is intended to act locally at the site of injection to reduce muscle spasticity, and intravenous administration would not achieve the desired localized effect.

Choice C reason: Subcutaneous injection is not the correct method for administering botulinum toxin. This medication needs to be injected directly into the muscle to have a therapeutic effect on muscle spasticity.

Choice D reason: Intramuscular injection is the correct method for administering botulinum toxin. The medication works by blocking the release of acetylcholine at the neuromuscular junction, thereby reducing muscle spasticity. Administering it directly into the muscle ensures that the medication reaches its target and provides the desired therapeutic effect.