– 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 infant’s 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.