Myelomeningocele

the nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. which would be a priority nursing diagnosis before surgery 1. alteration in parent infant bonding 2. altered growth and development 3. risk of infection 4. risk for weight loss

3 a NS dressing is placed over the sac to prevent tearing which would allow the CSF to escape and microorganisms to enter and cause infection

the parents of a child newly dx with myelomeningocele ask the nruse why surgical repair needs to be done immediately. Which reponse would be most accurate 1.Its done to rapidly resotre neural pathways to the legs 2.Its done to decrease the possibility of infection and further cord damage 3.Its done to expose the spinal cord defect and allow an individualized therapeutic strategy 4.Its done to remve excess nerve tissue from the vertebral canal and to decrease pressure on the cord

2

A nurse is caring for a neonate born 12 hours ago with a myelomeningocele. Which assessment finding should be reported immediately to the PCP 1.Axillary temp of 102.2 2.Dribbling of urine 3.No lower limb movement 4.Talipes equinavaraus

1 infection

the nurse is caring for an infant with a myelomeningocele. the parents ask the nurse why they keep measuring the babys head circumference. select the nurses best response 1. babies heads are measured to ensure growth is on track 2. babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size 3. because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size 4. many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size

2. children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increased in head circumference

A mother of a 3yo with a myelomeningocele is considering having another baby. She asks the nurse if she should make any changes to her diet. What is the nurses best response 1.Increase folic acid to 0.4mg 2.Increase folic acid to 4mg 3.Increase vitamin b12 to 0.4mg 4.Increase vitamin b12 to 4mg

B

an infant has returned ot the peds unit after repair of a meylomeningocele. The nruse notices that the infant has had no urine output in the past 2 hours. Which nursing intervention would be most appropriate 1.Perform credes maneuver ont eh infants bladder 2.Catheterize the ifnants bladder 3.Ask the mother to breast feed the infant 4.Increase the IV fluid rate

2

the nurse is working in a schol health clinic and a teen mentions that her older sister just had a baby born with a myelomeningocele. the teen is wondering if there is anything she can do to prevent this from happening to her baby when she decides to have children. which is the best response 1. take a multivtaim with folic acid daily 2. eat more fruits and vegetables daily 3. have breakfast every morning 4. there is nothing that can be done to decrease the risk

1 0.4mg of folic acid daily for all women of childbearing age

which priority item should be placed on the bedside of a newborn with myelomeningocele 1. a bottle of NS 2. a rectal thermometer 3. extra blankets 4. a bp cuff

1 before the surgical closure of the sac, the infant is at risk for infection. a sterile dressing is placed over the sac to keep it most and help prevent it from tearing

a child with a repaired myelomeningocele is in the clinic for a regular exam. the child has frequent constipation and has been crying at night bc of pain in the legs. after an MRI the diagnosis of a tehered cord is made. which should the nurse tell the parents 1. tehtered cord is a post surgical complicaiton 2. thered cord occurs during times of slow growth 3. release of the tethered cord will be necessary only once 4. offering laxatives and acetminophen daily will help control these problems

1 thered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect the bowel, bladder or lower extremity functioning

which is included in the plan of care for a newborn who has myelomeningocele 1. place the child in the prone position with a sterile dry dressing over the defect. slowly begin oral gastric feeds to prevent the development of nectrozing enterocolitis 2. place the child in the prone position with a sterile dry dressing over the defect. begin IV fluids to prevent dehydration 3. place the child in the prone position with a sterile most dressing over the defect. slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis 4. place the child in the prone position with a sterile most dressing over the defect. begin IV fluids to prevent dehydrations

4 the child is placed in the prone position to avoid any pressure on the defect. a sterile moist dressing is placed over the defect to keep it as clean as possible. IV fluids are begun to prevent dehydration

which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele 1. weight diapers for 24 hour urine output 2. measure head circumference 3. offer clear fluids 4. assess for infection

2 hydrocephalus occurs in about 90% of infants with myelomeningocele so measuring the head circumference daily and watching for an increase are imortant. accumulation of CSF can occur after closure of the sac

over the last week an infant with repiared myelomeningocele has had a high pitched cry and been irritable. length, weight and head circumference have been at the 50th percentile. today length is at the 50th percentile, weight is at the 70th percentile and head circumference is at the 90th percentile. the nurse should do which of the following 1. tell the parent this is normal for an infant with a repaired myelomeningocele 2. tell the parent this might mean the baby has increased icp 3. suspect the baby's icp is low because of a leak 4. refer the baby to the nuerologist for follow up care

2 the increase in head size is one of the first signs of icnreased ICP. other signs include high pitched cry, irritability

a newborn with a repaired myelomeningocele is assessed for hydrocephalus. which would the nurse expect in an infant with hydrocephalus 1. low pitched cry and depressed fontanel 2. low pitched cry and bulging fontanel 3. bulging fontanel and downwardly rotated eyes 4. depressed fontanel and upwardly rotated eyes

3 an alteration in the circulation of the CSF causes hydrocephalus. the anterior fontanel bulges becuase of an increase in CSF and increased ICP. increaesd ICP causes a high pitched cry in infants and downward deviation of the eyes, also called sunset eyes. with sunset eyes the sclera can be seen above the iris

which does the nurse include in a child with myelomeningocele postoperative plan of care following ligament release 1. encourage the child to resume a regular diet, begining slowly with bland foods that are easily digested, such as bananas 2, encourge the child to blow balloons to increase deep breathing and avoid postop pneumonia 3. assist the child to change positions to avoid skin breakdown 4. provide education on dietary requirements to prevent obesity and skin breakdown

3 preventing skin breakdown is important as pressure points are not felt easily

which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele. select all that apply 1. skull x rays 2. daily head circumference measurements 3. MRI scan 4. vital signs every 6 hours 5. holding to breastfeed

2,3 daily head circumference measurements are done to assess for hydrocephalus. diagnostic tests include MRI scan, CT scan, ultrasound and myelography

which should be included in the plan of care for a newborn with myelomeningocele who will have a surgical repair tomorrow 1. offer formula every 3 hours 2. turn the infant back to front every 2 hours 3. place a wet dressing on the sac 4. provide pain medication every 4 hours

3 priority care for an infant with this is to protect the sac. a wet dressing keeps it moist with less chance of tearing

a parent of a newborn diagnosed with myelomeningocele asks what is a common long term complication. the nurses best response is 1. learning disabilities 2. UTI 3. hydrocephalus 4. decubitus ulcers and skin breakdown

2 UTI are the most common complication. nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent UTI. frequent catheterization also increases risk of UTI

an infant is born with a sac protruding through the spine, containing CSF, a portion of meninges and nerve roots. the condition is referred to as 1. meningocele 2. myelomeningocele 3. spina bifida occulta 4. anencephaly

2 a myelomeningocele is a sac that contains a portion of the meninges, the CSF and the nerve roots

which should be the priority ND for a 12 hour old newborn with a myelomeningocele at L2 1. altered bowel elimination r/t neuro deficits 2. potential for infection r/t the physical defect 3. altered nutrition r/t neuro deficit 4. disturbance in self concept r/t physical disability

2 bc this infant has not had a repiar, the sac is exposed. it could rupture allowing organisms to enter the CSF

which should the nurse prepare the parents of an infant for the following surgical repair and closure of a myelomeningocele shortly after birth. the infant will: 1. not need any long term management and should be considered cured 2. not bo at risk for UTI or movement problems 3. have continual drainage of CSF needed frequent dressing changes 4. need lifelong management of urinary, orthopedic and neurological problems

4 although immediate surgical repair decreases ifnection, morbidity and mortality rates, these children will require lifelong management of neurlogical orthopedic and elimination problems