Nursing Care Plan for Neural Tube Defect, Spina Bifida

Pathophysiology

A neural tube defect is a birth defect of the brain, spine and spinal cord. In Spina Bifida, the spinal vertebrae do not fully form and close to protect the spinal cord, leaving an opening along the spinal column. There are three types of spina bifida that categorize the characteristics of the defect: spina bifida occulta is the mildest form of the defect in which there are gaps in the spine, but no opening on the back; meningocele is when a sac of fluid protrudes from an opening in the spinal column, but the spinal cord is not affected; myelomeningocele is when part of the nerves and spinal cord protrude through an opening in the spinal column. Myelomeningocele is the most severe and results in the greatest disabilities involving motor function, sensation and ability to move or control extremities.

Etiology

Genetics and some lifestyle factors such as drug use and improper nutrition of the mother affect the development of spina bifida in a fetus. It is suspected that a folic acid deficiency during the early stages of pregnancy may contribute to the risk of neural tube defects. Other risk factors include uncontrolled maternal diabetes, exposure to chemicals or toxins during pregnancy, and becoming overheated during pregnancy.

Desired Outcome

Patient will have  optimal motor function; patient will be free from infection; patient will be free from injury

Neural Tube Defect, Spina Bifida Nursing Care Plan

Subjective Data:

  • Muscle weakness
  • Lack of sensation

Objective Data:

  • Abnormal tuft of hair or dimple on back
  • Protrusion of a sac from an opening in the spinal column
  • Lack of movement in lower extremities
  • Urinary or fecal incontinence later in life (lack of control)

Nursing Interventions and Rationales

  1. Perform newborn assessment; APGAR score and physical examination

  2. Observe for presence of abnormalities or physical defects.

    Note spinal column, abnormal tufts of hair or dimples on infant’s back that indicate a closed neural tube defect or spina bifida occulta.

  3. Assess and monitor vital signs

  4. Gather baseline information, monitor for changes or signs of complications. Autonomic instability is possible with spinal cord involvement.

  5. Apply moist, sterile dressing over sac. Provide dressing care as needed and per facility protocol

  6. Moist dressings prevent drying of the sac that can cause rupture and risk infection.

  7. Assess temperature and signs of infection. Assess for irritation, redness, swelling or drainage around the sac.

  8. Exposure of a fluid sac or spinal cord through opening in the skin increases risk of bacterial infection

  9. Perform careful handling during nursing care. Change process of care activities as appropriate

  10. Be careful to avoid trauma to the sac to prevent further damage to the spinal cord

  11. Provide pre- and post- surgical care

  12. Surgical site care should be done using sterile technique following surgery to prevent infection.

  13. Administer medications appropriately

    • Antibiotics may be given empirically to prevent infections.
    • Antispasmodics and anticholinergics may be given to help bladder incontinence.

  14. Assess bowel and bladder function

  15. Note the presence of neurogenic bladder and amount of incontinent care required.

    Insert urinary catheter, provide catheter care, monitor urine output.

  16. Provide incontinence care as required

    • Perform intermittent catheterization as required. Can educate older patients to self-catheterize
    • Assist with bladder emptying as necessary (Crede’s maneuver).
    • Provide bowel and skin care to prevent skin breakdown

  17. Provide range of motion exercises

  18. Promote strengthening and prevent contractures and atrophy of muscles

  19. Provide assistance with assistive devices for mobility

  20. Patient may require splints, braces, wheelchair or other devices as he/she grows according to level of disability.

  21. Provide resources and education for parents / caregivers

    • Resources
    • Home care
    • Relieve anxiety
  22. Provide emotional support for care of patient. Relieve some stress by providing education and access to resources.


References

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