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CONGENITAL CONDITIONS-SPINA BIFIDA (Risk Factors (Folate Deficiency,…
CONGENITAL CONDITIONS-SPINA BIFIDA
Definition
Spina bifida is a birth defect where there is incomplete closing of the backbone and membranes around the spinal cord
Surgical Management
Fetal Surgery
Nerve function in babies with spina bifida can worsen after birth if it's not treated. Prenatal surgery for spina bifida (fetal surgery) takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord.
Meningocele Surgery
Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. Because the spinal cord develops normally in babies with meningocele, these membranes often can be removed by surgery with little or no damage to nerve pathways.
Classification
Spina Bifida Occulta
The mildest form, spina bifida occulta results in a small separation or gap in one or more of the bones of the spine (vertebrae)
Meningocele
In a form of spina bifida called meningocele, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae, forming a sac filled with fluid. But this sac doesn't include the spinal cord, so nerve damage is less likely, though later complications are possible.
Meningomyelocele
Also known as open spina bifida, myelomeningocele is the most severe form. The spinal canal is open along several vertebrae in the lower or middle back. The membranes and spinal nerves push through this opening at birth, forming a sac on the baby's back, typically exposing tissues and nerves. This makes the baby prone to life-threatening infections.
Symptoms
Spina bifida occulta. Because the spinal nerves usually aren't involved, typically there are no signs or symptoms. But visible indications can sometimes be seen on the newborn's skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmar
Meningocele. The membranes around the spinal cord push out through an opening in the vertebrae, forming a sac filled with fluid, but this sac doesn't include the spinal cord.
Myelomeningocele. In this severe form of spina bifida
The spinal canal remains open along several vertebrae in the lower or middle back.
Both the membranes and the spinal cord or nerves protrude at birth, forming a sac.
Tissues and nerves usually are exposed, though sometimes skin covers the sac.
Causes
Doctors aren't certain what causes spina bifida. As with many other problems, it appears to result from a combination of genetic and environmental risk factors, such as a family history of neural tube defects and folate deficiency.
Risk Factors
Folate Deficiency
Family History Of Neural Tube Defects
Medication
Diabetes
Obesity
Increased Body Temperature
Diagnostic Studies
Maternal serum alpha-fetoprotein (MSAFP) test.
Amniocentesis
Ultrasound
Pathophysiology
Spina bifida is sometimes caused by the failure of the neural tube to close during the first month of embryonic development (often before the mother knows she is pregnant). Some forms are known to occur with primary conditions that cause raised central nervous system pressure, raising the possibility of a dual pathogenesis
Medical Mangement
Antiseizure medicine helps control and prevent seizures.
Anticholinergics help the child urinate.
Nursing Care Plan
Risk for Infection
Goals and outcomes
Patient remains free of infection, as evidenced by normal vital signs and absence of signs and symptoms of infection.
Patient remains free of infection, as evidenced by normal vital signs and absence of signs and symptoms of infection.
Nursing Assessments
Monitor white blood cell (WBC) count
Assess and monitor nutritional status, weight, history of weight loss, and serum albumin.
Investigate the use of medications or treatment modalities that may cause immunosuppression
Monitor forRedness, swelling, increased pain, purulent discharge from incisions, injury, and exit sites of tubes (IV tubings), drains, or catheters.
Nursing Intervention
Maintain or teach asepsis for dressing changes and wound care, peripheral IV and central venous management, and catheter care and handling.
Encourage intake of protein-rich and calorie-rich foods.
Encourage fluid intake of 2,000 to 3,000 mL of water per day, unless contraindicated.
Health Education
Help prevent obesity: Children with spina bifida are at risk for obesity. Feed him healthy foods, such as fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish.
Care for the bladder and bowels: Clean the child's diaper area well to avoid infection or other health problems.
Protect the child's skin: Help him move or change positions often if he lies down or sits for long periods of time. This will help prevent sores on his skin. Check his skin often for redness or blisters
Nursing Mangement
Physical examination. When collecting date during the examination, observe the movement and response to stimuli of the lower extremities; carefully measure the head circumference and examine the fontanelles.
Assessment of knowledge regarding the defect. Determine the family’s knowledge and understanding of the defect, as well as their attitude concerning the birth of a newborn with such serious problems.
