Latex allergy is suspected in a child with spina bifida.

Which of the following interventions by the assistive personnel would the nurse querry

Choice A rationale

Positioning an infant with myelomeningocele in the supine position increases the risk of rupture or damage to the delicate sac, which contains neural tissue and cerebrospinal fluid. Proper positioning requires the infant to be prone or side-lying to prevent pressure on the defect, protecting the integrity of the meningeal sac before surgical repair. A pillow under the buttocks when supine does not eliminate the risk.

Choice B rationale

Covering the sac with a sterile, moist, nonadhesive dressing, such as saline-soaked gauze, is essential preoperative care. This prevents the sac from drying out and maintains the viability of the exposed neural tissues, while the nonadhesive nature minimizes tissue trauma upon removal. Saline is used as an isotonic solution that avoids osmotic shifts in the exposed tissue.

Choice C rationale

Wrapping the infant snugly in a blanket should be avoided because the pressure exerted by the blanket could easily rupture the fragile meningeal sac. The goal is to minimize all external pressure and contact with the defect site to prevent infection and further neurological damage prior to surgical closure.

Choice D rationale

Applying a diaper is contraindicated as the diaper edges would rub against the sac, causing irritation, potential breakdown, and increasing the risk of contamination from urine and feces. The sac must be kept clean and dry from contaminants; therefore, the infant is typically kept in an incubator without a diaper.

Choice A rationale

While a shunt insertion for hydrocephalus aims to drain excess cerebrospinal fluid and reduce intracranial pressure, thereby minimizing brain damage, it does not completely eliminate the risk of developmental problems. The extent of pre-existing neurological damage influences long-term outcomes, and some children may still experience learning disabilities or motor deficits requiring ongoing therapy and support.

Choice B rationale

The risk of shunt infection is present throughout the device's life, although the greatest risk does occur in the early post-operative period, typically within the first few months. Infections can be caused by skin flora introduced during surgery and can lead to serious complications like ventriculitis or septicemia, often requiring shunt removal and IV antibiotics.

Choice C rationale

Shunts have a fixed length; as the child grows, the distal catheter (the end draining the fluid) may no longer reach the peritoneal cavity or atrium, leading to shunt malfunction. Furthermore, components can fail over time due to wear or blockage, necessitating surgical revisions or replacement throughout the individual's lifetime to maintain proper cerebrospinal fluid drainage.

Choice D rationale

A ventriculoperitoneal or ventriculoatrial shunt is a palliative measure that manages the primary complication of hydrocephalus, which is increased intracranial pressure. However, shunts are prone to complications such as malfunction due to blockage, disconnection, or infection, and they do not cure the underlying cause, meaning that further complications remain a possibility.