Question

Formulate a nursing care plan for the preoperative and postoperative care of a child with myelomeningocele.

Answer 1

Ans) Child with myelomeningocele:

Preoperative care:

- Initial assessment after delivery will reveal a visible external sac protruding from the spinal area. It is most often seen in the lumbar region but can be anywhere along the spinal canal.

- Most are covered with skin and pose no threat to the child. However, assessment to ensure that the sac covering is intact remains important.

- Assess neurologic status carefully.

- Before surgical correction the infant will be thoroughly examined to determine whether there is any neural involvement or associated anomalies.

- Diagnostic procedures such as computed tomography (CT), MRI, and ultrasound may be performed.

Postoperative care:

- Teaching should begin immediately in the hospital.

- Teaching should include positioning, preventing infection, feeding, promoting urinary elimination through clean intermittent catheterization, bowel elemination, preventing latex allergy, and identifying the signs and symptoms of complications such as increased ICP. Due to the chronic nature of this condition, long-term planning needs to begin in the hospital.

- These children usually require multiple surgical procedures and hospitalizations, and this can place stress on the family and their finances.

- The nurse has an important role in providing ongoing education about the illness and its treatments and the plan of care. As the family becomes more comfortable with the condition, they will become the experts in the child's care. Respect and recognize the family's changing needs.

- Providing intense daily care can take its toll on a family, and continual support and encouragement are needed.

- Association and a local support group for families of children with myelomeningocele is supported.