What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele?

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.