Transillumination of the sac: Differentiates between myelomeningocele
and meningocele. A meningocele sac does not transilluminate. This test
is performed if the sac is present after birth.
CT scan: Assess the presence of a neural tube defect after birth.
Radiograph: Assess the presence of a neural tube defect after birth.Treatment
Surgery within 48 hours of birth to close the opening to decrease the risk
of infection and prevent spinal cord damage.
Insert a shunt to relieve hydrocephalus.Nursing alertSurgery does not reverse the disorder.Nursing Intervention
Prenatal:- Encourage the mother to take adequate amounts of folic acid during
childbearing years. - Explain the disorder and treatment following birth.
After birth: - Lay the infant on his side to prevent pressure on the sac.
- Keep the sac covered with a sterile dressing soaked in warmed saline
solution to keep the sac moist. - Place a strip of plastic below the sac to prevent contamination from
urine and stool to prevent infection. - Measure head circumference to determine if hydrocephalus develops.
- Monitor for infection.
- Assess for leakage around the sac.
- Assess bladder and bowel function.
- Assess neurologic signs.
- Reposition the patient every 2 hours to prevent pressure ulcers and
contractures. - Explain to the family that surgery will be performed to close the
opening within 48 hours following birth.
After surgery: - Monitor vital signs.
- Monitor for signs of infection.
- Reposition the patient every 2 hours to prevent pressure ulcers from
developing. - Monitor bowel and bladder function to assess for changes from the
preoperative period. - Assess neurologic signs.
(^214) Pediatric Nursing Demystified