University:
Northwest College
Course:
VN420 | Child Health
Academic year:

2024
Views:

371

Pages:

3
Author:

Yesenia M.

MYELOMENINGOCELE Most severe form of neural tube defect Occurs in 1 in 4000 live births Is a type of spina bifida Can be dx via US – otherwise its obvious at birth NB with myelomeningocele is at > r/o meningitis, hypoxia or hemorrhage The spinal cord often ends at the point of the defect resulting in absent motor and sensory function at that point. LT complications- paralysis, orthopedic deformities, bladder and bowel issues Freq caths→ increase r/o UTIS, pyeloneohritis, hydronephrosis which can lead to LT renal damage . ALSO AT RISK OF LATEX ALLERGY** Can also suffer from hydrocephalus ** - the LOWER the deformity is on the spine, the lower the risk of hydrocephalus These children usually have multiple sx procedures Learning problems and seizures also common Some children can ambulate w no issue, others cannot. PARALYSIS. PATHOPHYSIOLOGY: cause is UNKNOWN Risk factors → maternal drug use, malnutrition, genetic predisposition Neural tube usually closes at 4th wk- it FAILS to close in myelomeningocele External sac like protusion encases the meninges, spinal fluid, and nerves, can be located anywhere but usually is on LUMBOSACRAL area THERAPEUTIC MANAGEMENT: Surgical closure ASAP after birth- to prevent infection and minimize further loss of function Will need lifelong follow up ASSESSMENT: Monitor risk factors- lack of prenatal care, lack of preconception and or prenatal folic acid supplementation Previous child w neural tube defect or family hx Maternal use of drugs that antagonize folic acid , like anticonvulsants (carbamezapine and phenobarbital) S/S: Mobility or motor changes GU function changes Bowel changes s/s of UTI hx of hydrocephalus w shunt latex sensistivity nutrition changes changes in physical or cognitive visible sac on spinal area flaccid paralysis absence of DTRS lack of response to touch or stimuli clubbed feet constant dribbling of urine relaxed anal sphincter NURSING MANAGEMENT PREVENTING INFECTION: keep the sac from drying out, prevent trauma or pressure . use sterile saline soaked nonadhesive gauze to cover . report any leakage Position the infant PRONE or on the side Keek the infant warm, place in warmer to avoid blankets which can put pressure on the sac Keep lesion free of urine or feces – clean them often URINARY/BOWEL ELIMINATION: Often incontinent Evaluate renal function should be done Bowel training w use of enemas or suppositories + diet modifications NUTRITION: Assist in assuming natural feeding position Infants head can be turned to the side or the infant can be placed on a side lying position.