5. 2. 6. 90-95% develop signs and symptoms of hydrocephalus (see p. 274).
      7. May have associated orthopedic anomalies: clubfoot, developmental hip dysplasi
   3. Analysis/nursing diagnosis:
      1. Risk for injury/infection related to rupture of the sa
      2. Altered urinary elimination related to urinary retention and overflow incontinenc
      3. Impaired skin integrity related to immobility.
      4. Constipation related to fecal incontinence and impaired innervation.
   4. Nursing care plan/implementation:
      1. Goal: prevent rupture of the sac and possible infection (preoperative).
         1. Position: no pressure on sac; prone to prevent contamination with urine or stool.
         2. No clothing or diapers to avoid pressure on sa
         3. Place in heated isolette to maintain body temperatur Avoid radiant heat, which can dry and crack the sa
         4. Keep sac covered with sterile, moist, nonadherent dressing (sterile normal saline) to prevent drying, cracking, and leakage of CSF; change every 2-4 hr; document appearance of sac each dressing change to note signs and symptoms of infection, leaks, abrasions, or irritation.
         5. Enforce strict aseptic technique to prevent infection (leading cause of morbidity/mortality in neonatal period).
         6. Avoid repeated latex exposure (, gloves, catheters) to decrease risk of latex allergy.
      2. Goal: prevent infection in postoperative perio
         1. Position: prone, side-lying, or partial sidelyin
         2. Use myelomeningocele apron (specific type of dressing) to prevent urine or stool from contaminating suture lin
         3. Administer antibiotics as ordere
         4. Use strict aseptic techniques in dressing ® changes; standard precautions to prevent infection.
      3. Goal: prevent urinary retention and UT
         1. Monitor I&O, offer extra fluids to flush kidneys.
         2. Keep urethral meatus clean of stool to prevent ascending bacterial infection.
         3. Monitor urinary output for retention.
         4. Administer antibiotics/urinary tract antiseptics as ordere
      4. Goal: prevent complications of prolonged immobility or associated orthopedic anomalies.
         1. Position: hips abducte
         2. Use positional devices, rotating pressure mattress/flotation mattress.
         3. Refer to physical therapy for ROM exercises.
         4. Make necessary referrals for care of possible clubfoot/developmental hip dysplasi
      5. Goal: monitor for possible development of hydrocephalus. Occurs in 90-95% of infants born with myelomeningocel
   5. Evaluation/outcome criteria:
      1. Integrity of sac is maintained until surgery is done.
      2. No infection occurs.
      3. Adequate patterns of urinary and bowel elimination with necessary support.
      4. Complications of immobility, orthopedic anomalies are prevented or treated promptly.