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Pediatric Nursing and child health care 70 defect is greater than was thought. If there is possibility that the spinal cord may be involved in the defect, surgical treatment is indicated. Meningocele: On examination the newborn infant is found to have a defect on the spinal column large enough to protrude through the opening. There is generally no evidence of weakness of the legs, the infant straitens and kicks in normal manner, or if lack of spincter control, though this is difficult to a certain in the newborn. The prognosis is excellent if surgical correction is done on this defects. Hydrocephalus may be an associated finding or may be aggravated after operation for a meningocele. Meningomyelocele: In this condition an imperfectly developed segment of the spinal cord as well as the meninges, protrudes through the spina bifida in the lumbosacral region. There may be a minimal weakness to a complete flaccid paralysis of the legs and absence of sensation in the feet. Operation removes a cosmetically unacceptable deformity, prevents infection and in many instance improves the neurological deficit since obstruction is removed from the nerve path ways. Pediatric Nursing and child health care 71 Responsibilities of nurse preoperatively in Meningomyelocele Until the operation is performed the newborn should be kept flat on his abdomen with sterile pad over the lesion. No pressure over meningocele sac. Prompt surgical closure of the skin defect preferably within 24 to 48 hours after birth is done to prevent meningeal irritation. Responsibilities of Nurse post operatively: • Observing and reporting of all signs and symptom of the infant’s condition. • Temperature, pulse, and respiration (vital signs) must be noted frequently. • Symptoms of shock must be noted • Oxygen must be kept near to bed • Abdominal distension caused by paralytic illus or distention of the bladder following most spinal cord surgery should be reported. • The surgical dressing must be kept clean and dry. 5.7 Hydrocephalus: Hydrocephalus is a condition due to inadequate absorption of cerebrospinal fluid with a corresponding increase of fluid under pressure within the intracranial cavity to obstruct within the ventricular system. Pediatric Nursing and child health care 72 The obstruction inflow cerebrospinal fluid may be due to one of several causes. Congenital mal development of the ventricular foramina. Neoplasm may be present or fibrous residue making it may occlude the reabsorptive surface. Hemorrhage from trauma may cause hydrocephalus in the young infant. The accumulation of fluid in the ventricles generally enlarges the infants skull, since the suture are not closed and the bones are soft. Treatment: should be started as soon as the clinical manifestations are observed, before damage to the brain itself. Several shunting procedures are now in use eg. Ventriculovenostomy (shunting from the ventricle through the internal juqular vein to the right atrium of the heart), ventriculo peritoneostomy, ventriculoureterostomy, and lumbar subarachnoid pertoneostomy. The prognosis is dependant to a great extent on the promptness of treatment and the kind of operation performed. Responsibility of the Nurse: Observing the degree of irritability and changing vital signs should be reported promptly. Frequent change of position to prevent hypostatic pneumonia and danger of pressure sore. Pediatric Nursing and child health care 73 If pressure areas develop, great care must be taken to prevent infection. When lifting head must be supported in order to prevent trauma. Postoperative care: - The temperature, pulse and respiration should be observed every 15 minutes until the infant is reactive. - Signs of increased intracranial pressure (irritability, bulging of the fontanel, lethargy, vomiting, elevated systolic blood pressure, change in the pulse and respiration rate, change in body temperature must be recorded and reported. - If temperature is elevated tepid sponging may be used or aspirin may be given. - IV fluid must be given slowly until the infant can be fed orally. - Mucus from nose and mouth should be aspirated to prevent the danger of aspiration. - The child should be turned at least every two hourly. 5.8
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