spina bifida

Spina Bifida Nursing Care Plans Diagnosis and Interventions

Spina Bifida NCLEX Review Care Plans

Nursing Study Guide on Spina Bifida

Spina bifida is a condition characterized by non-closure or defective closure of the vertebral column. It is a subtype of neural tube defects.

The neural tube is the building block of the brain and spinal cord which makes up the central nervous system.

The neural tube forms during the first few days of pregnancy and completely closes by the 28th day into conception.

In patients with spina bifida, a portion of the neural tube does not form properly.

Spina bifida is known as the most common central nervous system malformation and is second in the leading causes of birth defects.

Spina bifida occurs in 1 of 1000 births worldwide. Though the cause is unknown, low folate level is known to increase the risk of it occurring.

Spina bifida can happen anywhere along the spine. However, it is commonly seen in the lower thoracic, lumbar, and sacral region. Its severity depends on its subtypes.

Types of Spina Bifida

  • Spina Bifida Occulta. The Latin word “Occulta” means “hidden”. Spina bifida occulta is the mildest form of spina bifida. In this form of spina bifida, the gap in the spine is small and there is no opening or sac formation at the back of the patient. The nerves are usually intact; hence, no disability is expected. It is normally discovered only by accident when going for a scan for something else.
  • Meningocele. In this type of spina bifida, a sac of fluid comes out of the baby’s back through an opening. However, the spinal cord does not go into the sac; hence, there is usually no nerve damage involved. Minor disabilities may occur in this type of spina bifida.
  • Myelomeningocele. Myelomeningocele is the most common type of spina bifida. This is what people normally refers to when they talk about spina bifida. This type involves the formation of a sac on the baby’s back. A part of the spinal cord goes into the sack and nerve damage is present. This type causes moderate to severe disabilities including loss of sensation in the person’s lower extremities.

Symptoms of Spina Bifida

The signs and symptoms of spina bifida varies greatly on its type.

In spina bifida occulta, signs and symptoms are not usually present. More often, the condition is identified through accidental means like having to go for a scan for something else.

However, it may be noted that the skin at the baby’s back may show dimpling, birthmark, or even a tuft of hair.

In the most severe type of spina bifida, myelomeningocele, the following can be noted:

  • Protrusion of the spinal cord and nerves on the patient’s back forming a sac
  • Exposed tissues and nerves
  • Open spinal canal in the lower or middle back.

Causes of Spina Bifida

The exact causes of spina bifida remains unknown. It is noted, however, that there seems to be a genetic factor involved.

Risk factors were identified to have increase the possibility of the baby from developing spina bifida, which include:

  • Folate deficiency. Vitamin B9 or folate plays a significant role in the development of a baby as it is a cofactor in DNA and RNA biosynthesis. It is also involved in the formation of white and red blood cells.
  • Family history of neural tube defects. History of spina bifida or any other neural tube defect in both parents increases the risk of the baby developing spina bifida. The risk of it developing is also increased with the history of having neural tube defects in previous pregnancies.
  • Medications. Some drugs are known to increase the risk of spina bifida. The use of anti-seizure medications should be reviewed by a doctor as soon as pregnancy is discovered or when planning to get pregnant.
  • Diabetes. A poorly controlled diabetes can predispose a pregnant woman’s baby to develop spina bifida. Diabetes has microvascular and macrovascular complications that may affect the formation of the baby while in the mother’s womb.
  • Obesity. Obesity tends to increase the risk of neural tube defects in babies.
  • Hyperthermia in the early weeks of pregnancy. An elevated body temperature, either pathological or not, can predispose a woman to have a baby with spina bifida.

Complications of Spina Bifida

Spina Bifida can cause the following complications:

  1. Mobility problems. Depending on the severity of spina bifida, and the nerves involved, issues with sensation and muscle control can become apparent. In worst cases, paralysis may happen.
  2. Orthopedic complications. The position of spina bifida, especially in cases of myelomeningocele, can cause orthopedic issues such as scoliosis, abnormal growth, dislocated hips, bone and joint deformities, and muscle contractures.
  3. Bowel and bladder issues. Depending on the location of spina bifida, nerves controlling the bowels and bladder may become affected causing problems in the functions of the bladder and bowels.
  4. Hydrocephalus. Hydrocephalus refers to the accumulation of fluid in the brain.
  5. Shunt malfunction. Shunts are placed surgically in the brain to treat hydrocephalus.
  6. Chiari malformation type II. This is commonly noted in patients with myelomeningocele. It involves the brainstem to elongate possibly causing issues with breathing and swallowing.
  7. Meningitis. Meningitis refers to an infection in the brain. In cases of spina bifida, infection can climb up the brain through the opening in the patient’s back.
  8. Tethered spinal cord. This complication may appear after surgical closure of the opening. It occurs when part of the spinal cord adheres to the scar from the surgery.
  9. Sleep disorders. Apnea can stem from having spina bifida.
  10. Skin problems. Since spina bifida can cause reduced sensation on the lower extremities, wounds on this part of the body may not be noted by the patient, hence no treatment is often given.
  11. Latex allergy. It is noted that patient’s with spina bifida have a higher risk of developing latex allergy.

Diagnosis of Spina Bifida

The more severe cases of spina bifida can be diagnoses during pregnancy or as soon as the baby is born. It is only the spina bifida occulta that may have the possibility of not being diagnosed in the patient’s lifetime.

  • AFP test – alpha-fetoprotein can be detected in the mother’s blood during pregnancy. It is a protein produced by the baby. A high level of AFP may suggest spina bifida.
  • Ultrasound – most common form of imaging regularly conducted during pregnancy.
  • Amniocentesis – involves the insertion of a needle into the womb to get amniotic fluid. It will test for AFP.

Treatment for Spina Bifida

Mild cases of spina bifida may not require treatment. However, the more severe type will need to be immediately addressed:

  1. Prenatal surgery. Surgery may be performed in the unborn fetus at 26 weeks age of gestation. Reports show that patients who had the surgery at this stage may have reduced disability and less likely to develop complications.
  2. Caesarean birth. In cases of spina bifida, a caesarean birth or C-section is the preferred method of delivery. It is not a treatment for spina bifida, but it prevents further complications from happening.
  3. Surgery after birth. Myelomeningocele needs to be surgically corrected. It will help to prevent complications and infections.
  4. Folate supplementation. For pregnant women, taking folate regularly as soon as pregnancy is identified is recommended.

Nursing Care Plans for Spina Bifida

Nursing Care Plan 1

Nursing Diagnosis: Hypothermia related to spina bifida, as evidenced by loss of fluid and heat from the exposed sac, temperature of 34 degrees Celsius, and cold skin

Desired Outcome: The infant will have a normal temperature between the range of 36.5 to 37.5 degrees Celsius.

InterventionRationale
Put the infant on strict temperature monitoring (every 2 to 4 hours). Note the temperature of the extremities as well.To monitor any changes on the patient’s body temperature.
Post-operatively, wrap the infant in a blanket and place the infant under a radiant warmer or inside an incubator, while ensuring that the sac remains moist.To provide controlled warmth to the infant and prevent any further heat loss that may worsen hypothermia.
Teach the parent/s on how to use the thermometer and how to do regular monitoring of temperature.To empower the parents in monitoring any changes on the patient’s body temperature.
Inform the patient’s parents the ideal room temperature and the proper amount of clothes to put on.To provide an optimal environment for the infant.

Nursing Care Plan 2

Nursing Diagnosis: Impaired Urinary Elimination related to neuromuscular defect secondary to spina bifida as evidenced by urinary retention, urinary incontinence, and decreased bladder tone

Desired Outcome: The child will be able to achieve a more functional urinary elimination capacity as he/she turns to school age.

InterventionRationale
Assess and monitor the characteristics of urine, such as amount, frequency, color, odor, and turbidity.Dark, foul-smelling, bloody, and/or cloudy urine may indicate a urinary tract infection, particularly bladder infection due to urinary retention.
Perform a bladder scan.To determine the degree of urinary retention.
Encourage the child to drink oral fluids at least 30mL/lb/day.To increase blood flow in the renal system.
Educate the parents to encourage the female child in performing proper hygiene by wiping from front to back; the male child should also be encouraged to clean genital and anal areas after every episode of elimination.To prevent the introduction of microbes into the urethra, causing infection.
Administer prescribed medications such as anticholinergics and antispasmodics.To promote bladder action, thereby promoting urinary continence.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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