A nurse is planning care for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Which of the following interventions should the nurse include in the plan of care?

A. Semi-Fowler's. While this position can help with drainage, it is generally not the first choice immediately after VP shunt surgery.

B. Prone.This position is generally not recommended as it can cause discomfort and increase intracranial pressure.

C. Trendelenburg. This position is contraindicated as it can significantly increase intracranial pressure.

D. on the unoperated side. This position helps prevent pressure on the operative site and facilitates drainage of cerebrospinal fluid. It also reduces the risk of complications associated with increased intracranial pressure.

The correct answer is d. Modify the environment.

Rationale for each choice:

Choice a. Improve the client's communication skills.

• Statement:While communication is important,it is not the priority for a child with hemiplegic cerebral palsy.
• Rationale:Hemiplegic cerebral palsy primarily affects motor skills,not communication abilities.While some children with hemiplegic cerebral palsy may have speech difficulties,it is not the most pressing concern in this case.Addressing environmental barriers to promote mobility and independence takes precedence.

Choice b. Provide respite services for the parents.

• Statement:Respite services can provide valuable support for parents,but they are not the priority in this case.
• Rationale:The focus of the care plan should be on the child's immediate needs and safety.Modifying the environment to enhance the child's functional abilities is crucial for their development and well-being.

Choice c. Foster self-care activities.

• Statement:Encouraging self-care is essential,but it requires a supportive environment.
• Rationale:Before promoting self-care activities,the nurse must ensure the child has the necessary accommodations and modifications in place to facilitate independence.

Choice d. Modify the environment.

• Statement:This is the priority goal for a child with hemiplegic cerebral palsy.
• Rationale:Modifying the home environment can significantly improve the child's mobility,safety,and ability to participate in daily activities.Examples of modifications include:
  • Installing grab bars in the bathroom
  • Widening doorways
  • Removing tripping hazards
  • Providing adaptive equipment such as special chairs or utensils
  • Ensuring adequatelighting