Spina Bifida

- It is a defective closure of the vertebral column. - It is more common in the lumbo sacral region. - It has varying degree of tissue protrusion through the bony cleft.

Spina bifida occulta

Occulta is Latin for hidden. This is one of the mildest forms of spina bifida. In occulta, the outer part of some of the vertebrae are not completely closed. The split in the vertebrae is so small that the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it may have some hair growing from it; there may be a dimple in the skin, or a birthmark.

Spina bifida cystica

In spina bifida cystica, a cyst protrudes through the defect in the vertebral arch. These conditions can be diagnosed in utero on the basis of elevated levels of alpha-fetoprotein, after amniocentesis, and by ultrasound imaging. Spina bifida cystica may result in hydrocephalus and neurological deficits

Meningocele

The least common form of spina bifida is a posterior meningocele (or meningeal cyst).

Myelomeningocele

In this, a serious and common form, the unfused portion of the spinal column allows the spinal cord to protrude through an opening. The meningeal membranes that cover the spinal cord form a sac enclosing the spinal elements. Spina bifida with myeloschisis is the most severe form of spina bifida cystica.

SPINA BIFIDA Nursing Intervention and Care Plan

March 4th, 2011 Admin

SPINA BIFIDA -It is a malformation of the spine in which the posterior portion of the lamina of the vertebrae fails to close. It may occur in almost any area of the spine but is most common in the lumbosacral region. Types of spina bifida : 1-Spina bifida occulta :in which the meninges are normal, the defect being only of vertebrae and covered by normal skin . 2-Meningocele :in which the meninges protrude through the opening in the spinal canal. 3-Meningomyelocele: in which both the spinal cord and the meninges protrude through the defect in the bony rings of the spinal canal. *The objectives of treatment and nursing care are to prevent infection of the sac and to help preserve whatever function is present orthopedically and urologicaly. *Early operation is advocated to prevent further deterioration of neural tissue. Responsibility of nurse in meningocele and meningomyelocele Until the operation is performed the newborn should be : 1- Kept flat on his abdomen with a single layer of sterile gauze. 2- The genitalia and buttocks must be kept clean. 3- The ankles should be supported with foam rubber pads so that the toes do not rest upon the bed. 4- Antibiotics must be given if infection is suspected. 5- Emptying the infants bladder every 2 hours during the day and once at night, pressure should be applied firmly but gently beginning in the umbilical area and slowly progressing under the symphysis pubis and toward the anus. 6- If evidence of urinary infection occur culture should be done to determine the antibiotics. 7- The infant should be held for his feeding. 8- The nurse records the activity of the legs and the degree of continence, whether there is constant or intermittent dribbling , noting whether there is retention of urine or fecal impaction .All the vital signs should be taken and recorded with extreme care. Responsibility of the nurse postoperatively 1. The nurse is responsible for observing temp,pulse,R.R,symptoms of shock, abdominal

distention. 2. Head circumference of the infant must be measured frequently. 3. Surgical dressing should be kept clean. 4. Cast applied to the child legs should be positioned properly and handled carefully. 5. Nutrition is important. Post operative rehabilitation -Orthopedic and urologic physician should be consulted during the infant first admission for evaluation. Habilitation of the child is necessary after operation.

Source: http://www.nursing-lectures.com/2011/03/spina-bifida-nursing-intervention-and.html

Symptoms Of Spina Bifida

Loss of bladder or bowel control Partial or complete lack of sensation Partial or complete paralysis of the legs Weakness of the hips, legs, or feet of a newborn Other symptoms may include: Abnormal feet or legs, such as clubfoot Build up of fluid inside the skull (hydrocephalus) Hair at the back part of the pelvis called the sacral area Dimpling of the sacral area

Diagnosis Of Spina Bifida

Prenatal screening can help diagnose this condition Pregnancy ultrasound Amniocentesis Tests done on the baby after birth may include x-rays, ultrasound, CT, or MRI of the spinal area.

Treatment Of Spina Bifida

Genetic counseling In some cases where severe defect is detected early in the pregnancy, a therapeutic abortion may be considered. After birth, surgery to repair the defect is usually recommended at an early age. Before surgery, the infant must be handled carefully to reduce damage to the exposed spinal cord. This may include special care and positioning, protective devices, and changes in the methods of handling, feeding, and bathing.

Nursing Intervention of Spina Bifida :

Assess the sac and measure the lesion Assess neurological system Assess and monitor for increasing ICP Measure head circumferences

 Protect the sac, cover with a sterile, moist (normal saline), nonadherent dressing and change the dressing every 2-4 hours Place patient in prone position and head to one side
Use antiseptic technique

Assess and monitor the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection Assess for hip and joint deformities Administer medication: antibiotics, anticholinergics, and laxatives as prescribed

Complications of Spina Bifida

Difficult delivery with problems resulting from a traumatic birth, including cerebral palsy and decreased oxygen to the brain Frequent urinary tract infections Hydrocephalus Loss of bowel or bladder control Meningitis Permanent weakness or paralysis of legs

Spina bifida And Nursing Care Plan

April 17th, 2011 Admin

Spina bifida Vertebral column fails to close during intrauterine development Three forms: 1. Spinal bifida occulta 2. Meningocele 3. Myelomeningocele

Spina bifida occulta: Failure of vertebral arch to close, a dimple occurs on the sacral area, may be covered by a tuft of hair. Meningocele: Protrusion of membranes of the meninges. Meninges consist of: dura mater, arachnoid, and pia mater) covered by thin membrane. No paralysis because spinal cord is not involved. Myelomeningocele: Protrusion of the meninges and spinal cord. Covered by thin membrane, Extent of paralysis depends on the location of the defect. Results in hydrocephalus Medical Management Same day surgery: correct defect, minimize complications, and prevent infection, Encourage folic acid 4mg Po with future pregnacies (conception-6 weeks) Nursing Interventions: Primary intervention after birth of infant with meningocele,and myelomeningocele is to cover defect with a sterile, saline-soaked dressing Maintains moisture Decrease infection Encourage parents to become involved with infant care ASAP Learn techniques: feeding, ROM exercises, positioning, catheterization, skin care, Nursing diagnosis Potential for infection R/T presence of infective organisms, non-epitheliazed meringue sac, paralysis. Potential for trauma R/T delicate spinal lesion Potential impaired skin integrity R/T paralysis, continual dribbling of urine Potential for complications R/T impaired circulation of CSF or neuro-muscular impairment