# A nurse is caring for a newborn diagnosed with myelomeningocele at the L3-L4 level. Which nursing intervention should be the highest priority immediately after birth? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542454 > language: ko > subject: Child Health ## 문제 A nurse is caring for a newborn diagnosed with myelomeningocele at the L3-L4 level. Which nursing intervention should be the highest priority immediately after birth? ## 보기 1. Position the infant prone to prevent pressure on the sac 2. Begin range of motion exercises to prevent contractures 3. Assess for signs of increased intracranial pressure 4. Cover the defect with sterile saline-soaked gauze **✔ 정답** **정답: 4** ## 해설 The highest priority is protecting the exposed neural tissue from infection and trauma by covering the defect with sterile saline-soaked gauze. Other interventions like prone positioning or ROM exercises are important but secondary or contraindicated immediately after birth. ## 심화 해설 Immediate Priority in Myelomeningocele Care The highest priority intervention immediately after birth for a newborn with a myelomeningocele at the L3-L4 level is to cover the defect with sterile saline-soaked gauze. The core pathophysiological concern is the exposure of neural elements, specifically the spinal cord and meninges, to the external environment. This open defect creates a direct portal for infection, such as meningitis, and allows for rapid fluid loss leading to desiccation of the neural tissues. The sac is extremely fragile and vulnerable to rupture, which would dramatically increase the risk of central nervous system infection and permanent neurological damage. The pre-surgical management simulation model described by Rosen and Angert underscores the critical nature of immediate, protective covering of the defect as a foundational step in delivery room management [1]. The procedure involves applying a sterile, non-adherent dressing moistened with warm, sterile normal saline. This intervention achieves two essential goals: it creates a physical barrier against bacterial contamination, and it prevents the delicate neural tissues from drying out. The dressing must be kept moist, and the infant is subsequently positioned to avoid any pressure on the sac, but the act of covering it takes temporal precedence to mitigate the immediate risk of infection and tissue injury [1]. While other interventions are important, they are secondary to protecting the exposed spinal cord from the moment of birth. - Option 1 (Prone positioning) is a crucial intervention to prevent sac rupture and pressure injury, but it is performed in conjunction with or immediately after the sterile dressing is applied. The dressing itself must be in place first to protect the defect when the infant is positioned. - Option 2 (Range of motion exercises) is a long-term rehabilitative need to address potential contractures from paralysis but is not an immediate life-saving priority in the delivery room. - Option 3 (Assessing for increased intracranial pressure) is a critical ongoing assessment because myelomeningocele is frequently associated with Arnold-Chiari II malformation and hydrocephalus. However, the initial assessment for signs like a bulging fontanel or altered neurological status occurs after the immediate physical protection of the exposed defect has been secured. The immediate threat to life and future function from infection and tissue desiccation is more time-sensitive.References (research sources) - [1]Meningomyelocele Simulation Model: Pre-surgical Management–Technical ReportResearch articleO M Rosen, Robert Angert (2018) · DOI: 10.7759/cureus.2231 ## 임상 시나리오 Myelomeningocele: Immediate Post-Birth CarePrioritizing Defect Protection to Prevent Infection The highest priority is to cover the defect with a sterile, non-adherent dressing soaked in warm, sterile normal saline. This creates a barrier against bacterial contamination and prevents desiccation of the exposed neural tissues. After the dressing is applied, position the infant prone to avoid any pressure on the sac. Use a diaper-free approach or apply a diaper loosely below the defect to prevent contamination with urine or stool. Maintain the dressing continuously moist with sterile saline until surgical repair. Frequently assess the sac for signs of leakage, rupture, or infection. Measure the sac size daily to monitor for changes. CautionDo not use dry dressings as they can adhere to the delicate tissue and cause trauma upon removal. Avoid latex-containing products due to the high risk of latex allergy in this population. Never apply direct pressure to the sac. ## 핵심 개념 - **Myelomeningocele** — The most severe form of spina bifida in which the spinal cord and meninges protrude through an opening in the spine, forming a sac on the back. - **Desiccation** — The process of extreme drying; in this context, the risk of the exposed neural tissues drying out if not kept moist, leading to cell death. - **Sterile saline-soaked gauze** — A non-adherent dressing moistened with warm, sterile normal saline used to create a physical barrier against bacteria and prevent tissue dehydration. - **Meningitis** — Inflammation of the protective membranes covering the brain and spinal cord, a primary infectious risk from an open neural tube defect. ## 같은 주제 문제 - [A nurse is assessing a newborn diagnosed with myelomeningocele. Which assessment finding w…](https://mymerci.kr/pages/nclex_q.php?qn_id=542451) - [A nurse is assessing a newborn with myelomeningocele. 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