Planning of the Nursing Care
1) Educate and teach the parents
2) Provide preoperative and postoperative care.
Educate an Teach the Parents
The parents may be distressed at the appearance of defect at birth, so that they need to be emotionally supported. Since the surgery is not performed immediately parents must be taught general care of the infant so that they can care their child at home.
The nurse teaches the parents how to keep the bladder area very clean and cover it with sterile petrolatum gauze to prevent infection and ulceration of the mucosa. Prevent the diaper adhering to the area. Diaper should be changed frequently for the comfort of infant and to prevent constant odor of urine. Stool is cleaned and removed immediately so that it does not contaminate the bladder mucosa. The nurse should perform all these activities in the presence of parents during hospitalisation and should allow the parents to do it under supervision. Urine sample can be taken from the opening of the bladder with medicine dropper or a syringe and or place the child in such a position over basin so that urine can drop into the container.
Provide Pre-operative and Post-operative Care
The time of surgical correction depends on severity of the defect. In case exstrophy is not complete, the abdominal wall and bladder are closed by plastic surgery. The infant may be able to void normally. Some times there may be the need of urinary diversion as the bladder control is not possible always.