Spina Bifida And Nursing Intervention

Spina Bifida

image– 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

image

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

 

Myelomeningocele

image

► 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.

 

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

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