A nurse is caring for a child with spina bifida.Which intervention is most important?

Choice A rationaleMonitoring for signs of infection is crucial in children with spina bifida due to the potential for meningitis and urinary tract infections related to neurological deficits and potential openings in the spinal cord. Normal white blood cell count ranges from 4,500 to 11,000 per microliter, and fever, redness, swelling, or purulent drainage would indicate infection.Choice B rationaleEncouraging mobility is important to promote development and prevent complications like contractures. However, in the immediate postoperative period or with significant neurological impairment, maintaining skin integrity takes precedence to prevent infection and further complications.Choice C rationaleProviding nutritional support is essential for growth and development in children with spina bifida, who may have feeding difficulties or increased metabolic needs. Adequate nutrition supports overall health, but preventing skin breakdown in areas prone to pressure is a more immediate concern.Choice D rationaleMaintaining skin integrity is the most important intervention because children with spina bifida often have sensory and motor deficits that make them susceptible to pressure ulcers, especially over bony prominences and the surgical site if a myelomeningocele repair has occurred. Skin breakdown can lead to serious infections and complications.