Pediatric Nursing
A neonate is admitted to the neonatal care unit with a meningomyelocele HR 130 RR 28 TEM 36.7 which of the…
A neonate is admitted to the neonatal care unit with a meningomyelocele HR 130 RR 28 TEM 36.7 which of the following actions should the nurse perform to prevent infection of the meningomyelocele sac?
الشرح
Core Concept: A meningomyelocele sac lacks normal skin coverage, leaving the neural elements and meninges exposed to the environment, creating a high risk for ascending central nervous system infections.
Clinical Presentation:
- Exposed neural placode and meninges in a sac on the back.
- Flaccid paralysis and absent reflexes below the lesion.
- Neurogenic bladder and bowel.
Diagnosis:
- First-line tool: Prenatal ultrasound and elevated maternal serum alpha-fetoprotein (MSAFP).
- Gold standard: Postnatal MRI of the entire spine and brain (to check for hydrocephalus/Chiari II malformation).
Management:
- Acute management: Place the infant prone or side-lying. Cover the defect immediately with a sterile, moist, non-adherent dressing (soaked in sterile normal saline) to prevent the sac from drying, rupturing, and leaking CSF, which prevents bacterial meningitis.
- Definitive management: Neurosurgical closure of the defect within the first 24-72 hours of life, followed by ventriculoperitoneal (VP) shunt placement if hydrocephalus develops.