What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele?
Positioning supine with a pillow under the buttocks.
Covering the sac with saline-soaked nonadhesive gauze.
Wrapping the infant snugly in a blanket.
Applying a diaper to prevent fecal soiling of the sac.
The Correct Answer is B
Choice A rationale
Positioning an infant with myelomeningocele in the supine position increases the risk of rupture or damage to the delicate sac, which contains neural tissue and cerebrospinal fluid. Proper positioning requires the infant to be prone or side-lying to prevent pressure on the defect, protecting the integrity of the meningeal sac before surgical repair. A pillow under the buttocks when supine does not eliminate the risk.
Choice B rationale
Covering the sac with a sterile, moist, nonadhesive dressing, such as saline-soaked gauze, is essential preoperative care. This prevents the sac from drying out and maintains the viability of the exposed neural tissues, while the nonadhesive nature minimizes tissue trauma upon removal. Saline is used as an isotonic solution that avoids osmotic shifts in the exposed tissue.
Choice C rationale
Wrapping the infant snugly in a blanket should be avoided because the pressure exerted by the blanket could easily rupture the fragile meningeal sac. The goal is to minimize all external pressure and contact with the defect site to prevent infection and further neurological damage prior to surgical closure.
Choice D rationale
Applying a diaper is contraindicated as the diaper edges would rub against the sac, causing irritation, potential breakdown, and increasing the risk of contamination from urine and feces. The sac must be kept clean and dry from contaminants; therefore, the infant is typically kept in an incubator without a diaper.
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Correct Answer is D
Explanation
Choice A rationale
Washing the cord daily with soap and water is not the current recommendation for routine cord care. Excessive handling and moisture can increase the risk of infection and delay drying and separation. Current evidence-based practice supports keeping the cord clean and dry without routine soap or alcohol application, promoting an air-exposed, natural healing process.
Choice B rationale
The cord should not be covered with a diaper, as this can trap moisture, promote bacterial growth, and delay the natural drying process, which should be the primary goal of cord care. The diaper should be folded down below the stump to allow for air circulation and reduce friction and contamination from urine or feces.
Choice C rationale
Applying petroleum jelly to the cord stump is not recommended as it keeps the cord moist, which can impede the natural mummification and drying process required for the stump to fall off, typically within 10 to 14 days. The goal of cord care is to keep the area clean and dry to facilitate air exposure and separation.
Choice D rationale
Giving a sponge bath is recommended until the umbilical cord stump has completely fallen off and the site is healed. Submerging the stump in bath water before separation can increase the risk of infection, as the moist environment is conducive to bacterial growth and delays the necessary drying and separation process.
Correct Answer is A
Explanation
Choice A rationale
Antiemetics are most effectively used by administering them proactively, before the chemotherapy agent is started, which is known as prophylactic use. This method allows the medication to achieve therapeutic serum levels and occupy receptors before the emetogenic chemicals stimulate the vomiting center in the brain, thus blocking the nausea pathway.
Choice B rationale
Waiting for nonpharmacologic methods to fail before using antiemetics is ineffective management. Chemotherapy-induced nausea and vomiting are best controlled with aggressive, scheduled pharmacologic intervention from the start, as it is far harder to stop vomiting once the emetic cycle has been established.
Choice C rationale
Starting antiemetics only when nausea begins is reactive and allows the patient to experience unnecessary distress and potential nutritional compromise. The goal in chemotherapy management is prevention; therefore, antiemetics must be started before the patient's exposure to the emetogenic stimuli.
Choice D rationale
Providing antiemetics as needed, or PRN, is a less effective strategy for chemotherapy-induced nausea and vomiting. The intensity of this type of emesis necessitates a scheduled regimen to consistently maintain therapeutic drug levels and prevent the overwhelming onset of nausea and vomiting, which can be difficult to manage once it starts.
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