Spina Bifida Nursing Care Plans Diagnosis and Interventions
Spina Bifida NCLEX Review and Nursing Care Plans
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:
- 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.
- 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.
- 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.
- Hydrocephalus. Hydrocephalus refers to the accumulation of fluid in the brain.
- Shunt malfunction. Shunts are placed surgically in the brain to treat hydrocephalus.
- 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.
- 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.
- 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.
- Sleep disorders. Apnea can stem from having spina bifida.
- 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.
- 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:
- 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.
- 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.
- Surgery after birth. Myelomeningocele needs to be surgically corrected. It will help to prevent complications and infections.
- Folate supplementation. For pregnant women, taking folate regularly as soon as pregnancy is identified is recommended.
Spina Bifida Nursing Diagnosis
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.
|Spina Bifida Nursing Interventions||Rationale|
|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.|
Spina Bifida 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.
|Spina Bifida Nursing Interventions||Rationale|
|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.|
Spina Bifida Nursing Care Plan 3
Nursing Diagnosis: Bowel Incontinence related to neuromuscular involvement secondary to spina bifida as evidenced by continuous dribbling and passage of watery stool.
Desired Outcome: The patient will be able to participate in bowel control and care regimen.
|Spina Bifida Nursing Interventions||Rationale|
|Evaluate the patient for the presence of neurogenic bowel, the level of incontinence, and the probability for recovery.||Neurogenic bladder is a medical condition wherein the patient lacks control of his bladder due to issues in the nervous system (i.e., brain, spinal cord, peripheral nerves). Being able to assess this accurately will help in determining care needs for the patient with spina bifida. Knowing the level of the patient’s incontinence and the chance of recovery will provide crucial information by providing the healthcare team the general outlook of the patient’s elimination patterns in relation to formulating management strategies.|
|Assist and allow the patient to sit in the bedside commode or toilet at the same time each day. Utilize stimulation and suppository if warranted.||Employing a schedule for bowel elimination establishes a definite pattern for his toileting needs, and in turn will allow for the patient to have a sense of control despite the condition.|
|Educate the caregivers or significant others on the correct way of cleaning the patient’s perianal area and diapering methods.||Utilizing the appropriate cleaning methods for the patient’s perianal area promotes understanding of the condition and its management that will help maintain good skin integrity.|
|Change the patient’s diaper once soiled with urine or feces as quickly as possible. Practice gentle cleaning of the perianal at all times.||Maintaining the patient’s skin moisture free eliminates opportunities for skin breakdown and the formation of moisture lesions.|
|Apply prescribed barrier creams in the perianal area after cleansing during diaper change sessions.||Barrier creams act as protection for the underlying skin against irritants that may otherwise cause incontinence-associated dermatitis, also known as IAD.|
|Ensure that the patient utilizes clothing and undergarments, even when the patient is using incontinence pads.||Clothing and undergarments protect the patient from staining accidents, due to the underlying condition, that may otherwise cause embarrassment to the patient. In addition, doing so will promote the patient’s self-image that is oftentimes compromised when having this condition.|
|Advise the patient to fluid intake of 2000 ml/day, still depending on age; ensure to include fiber in the diet as tolerated.||Adequate fluid intake ensures for better passing of stools by softening them. For those patients with watery stools, a diet rich in fiber and roughage promotes bulk formation thereby limiting liquid stools.|
|Ensure to put absorbent padding or rubber matting in the patient’s bed for bed ridden patients.||Bed ridden patients with uncontrolled bladder and bowel movements are prone in soiling their beddings. Use of waterproof padding ensures easy cleaning of the patient after each bout of elimination.|
|Educate the patient and caregivers on applicable programs for management of bowel incontinence, including importance of diet, fluid intake, routine toileting, etc.||Patients with spina bifida would need long-term management for their elimination patterns, especially those with uncontrolled conditions. Teaching of applicable therapeutic regimens will ensure the success of the patient’s bowel training regimen.|
|Educate about modifying behavior towards bowel rehabilitation for patients with spina bifida.||Behavior modification is desirable in order to promote compliance with methods in addressing issues with bowel training.|
Spina Bifida Nursing Care Plan 4
Nursing Diagnosis: Disturbed Body Image related to the biophysical and psychosocial aspect of the patient as evidenced by verbal expression of negative outlook regarding incapacities.
Desired Outcome: The patient will be able to express feelings about incapacity and identify at least one positive aspect of own body.
|Spina Bifida Nursing Interventions||Rationale|
|Evaluate the patient’s feelings about performing activities of daily living, especially the pros and cons in relation to spina bifida. Also include the perception about self and social interactions with others.||Gaining information on the patient’s outlook regarding the impacts of the condition will provide crucial data that will determine potential for patient independence regarding thinking and functioning.|
|Allow the patient to express concerns openly. Support communication of the patient with caregivers and others.||Allowing the patient to express their concerns openly gives them an avenue to vent out, thereby reducing negative emotions. It also reduces anxiety from the condition and creates opportunities for the patient to be heard.|
|Encourage the patient’s significant others to maintain psychological and physical support and care as much as possible.||Allowing for continuous interaction between the patient and significant others encourages acceptance of the patient with spina bifida. It also promotes social bonds and understanding of the condition for both the patient and significant other.|
|Allow for patient independence as much as possible. Exhaust self-care capabilities by utilizing aids for eating, dressing, bathing, grooming, mobility and toileting. Encourage and acknowledge patient attempts in doing self-care activities.||Encouraging patient independence will help in maintaining their capabilities in accomplishing personal care activities. Maximizing use of assistive devices further helps the patient maintain independence and self-worth.|
|Counsel significant others to maintain constant behavior guidelines for the patient with other members of the family. Also include the patient care and activities into the family routine.||Because of the debilitating and limiting nature of the condition, enjoining patient care and activities in the routine will eliminate alienating feelings and promote a sense of belongingness.|
|Observe and highlight the patient’s positive accomplishments and refrain from focusing on any negativity as much as possible.||Patients with spina bifida are prone to low self-esteem due to the debilitating and limiting nature of the condition. Focusing more on the positive aspects will enhance the patient’s confidence and promote better perception of body image.|
|Highlight the importance of therapeutic touch and other age-appropriate activities with peers.||Therapeutic touch can convey care and concern to the patient, thus improving relationship with significant others. Involving the patient with age appropriate activities prevents feelings of self-isolation and enriches socialization.|
|Educate the patient on the use of assistive devices and reassure on its safe usage.||Patients with spina bifida can be dependent on doing some, if not all, of their personal care activities. Educating them in the use of assistive devices will promote independence and better body image perceptions.|
Spina Bifida Nursing Care Plan 5
Nursing Diagnosis: Interrupted Family Processes related to situational crisis of long-term condition of patient secondary to spina bifida as evidenced by the family’s inability to adapt with the condition of the patient in a constructive approach.
Desired Outcome: The family will be able to adapt to the patient’s disability and exhibit motions to move forward.
|Spina Bifida Nursing Interventions||Rationale|
|Evaluate the patient and family’s level of understanding and perception of the crisis, their problem-solving skills and its effectiveness.||Assessing the level of understanding and perception will help the healthcare team formulate strategies that best address their specific concerns. Evaluating their problem-solving skills and its effect will reveal dynamics that would either need improvements or changes in order to cope with the crisis. It also promotes formulations of new interventions that are better suited for their needs in order for both the patient and family to adapt.|
|Evaluate the family’s capacity to adapt with their patient, the family developmental level, associated stress of family relationships, reaction of other family members, understanding of health practices, role behaviors and perception about prolonged care, financial burden, resources to prolonged care for the condition, grieving process, and clinical manifestations of depression, powerlessness and hopelessness.||Thorough evaluation of these dynamics will provide crucial information about family profile and adaptive capabilities that will profoundly affect the patient’s health and well-being. Presence of a debilitating condition can either strengthen or degrade relationships among family members, therefore producing undue problems and stress for the family.|
|Allow family members to express their feelings and concerns regarding the physical condition of their relative with spina bifida.||Verbalizations by the family of the condition will reduce their anxiety and apprehensions. It also provides an avenue for the family to display acceptance of their reactions.|
|Allow for the expression of family concerns. Make sure to provide accurate and honest information regarding care needs between those with or without surgical intervention done, including abilities and disabilities.||Allowing for verbalizations may reduce anxiety of the family. Furthermore, it also improves the family’s perception of the medical condition and its associated care needs of those afflicted.|
|Advise the family to maintain the health of family members and social contacts as healthy as possible.||Caregiver fatigue is the end result when family members care for their chronically-ill members. Encouraging the family to maintain optimal health and social bonds as much as possible will prevent chronic anxiety and seclusion on health and care needs of the family.|
|Practice empathy when dealing with both the patient and family. Support the caregiving efforts of the family.||Empathy shown and directed to both the family and patient will encourage adaptation and positive outlook towards condition. Likewise, showing encouragement will offer positive reinforcement of caregiver roles that will reduce stress among members.|
|Supplement and provide anticipatory assistance for crisis that may arise. Take note of cultural differences that may hinder or promote coping.||Anticipating family needs will ensure that they can adapt to undue stress and develop effective strategies to address new issues. Taking note of cultural differences will promote normalcy in the family dynamics.|
|Help the family in addressing family dynamics, especially tolerance levels regarding conflict and individual behavior.||Assisting the family to develop resolutions to their own issues will ensure that care for the patient is not compromised, integrity of relationships are maintained, and issues are addressed early on before it becomes difficult to solve.|
|Assist the family in recognizing methods to solve issues, adapt with the problem and regain control of the situation.||This allows for empathic support to the family, encourages self-determination in solving issues and proper management of the situation.|
|Assist the family in recognizing the realities of the condition. Propose access to various community sources, clergy, social services, and opportunities for physical and occupational therapy.||Caring for the chronically ill family member can be a burden for the family. The family having access to other sources of support will provide the needed assistance and expert advice to cope with the situation.|
|Educate the family that being overprotective to the patient may hinder his development and will make functioning in society much more difficult.||This enhances the family’s understanding of the condition. It also allows the patient to take active roles with family activities and dynamics, and thereby promoting self-determination and self-worth.|
|Make sure to reinforce positive adaptive behaviors.||Positive adaptive behaviors will encourage the family to take the constructive approach in taking care for their sick family member.|
|Educate the family on the causes, treatment and prognosis of spina bifida. Inform the parents that congenital defects are not necessarily their mistake. Likewise, assign the same caregiver for the patient if hospitalizations are frequent.||Relaying correct and accurate information to the family will promote better understanding of the disease that will aid in developing better methods to cope. Explaining that hereditary defects are not solely the fault of the parents will reduce guilty feelings that may hinder patient care. Assigning the same caregiver will ensure proper communication among members and enhancement of trust ties.|
|Instruct parents that surgical intervention would be done 48 hours after birth, postponed until the third month of life, or until adequate neurologic function is evaluated, to reduce hydrocephalus development and provide better epithelialization and wound healing.||Providing this information to the family, as reinforcement to doctors expert advice, will provide crucial when taking decisions to the appropriate surgical intervention.|
|Instruct the need for follow-up appointments with the care team, specifically the physician and therapists.||Spina bifida is a congenital flaw affecting the spine and spinal cord. It may have long-term effects that will hinder proper biophysical development. Compliance with check-ups will ensure that the therapeutic regimen is followed.|
More Nursing Diagnosis for Spina Bifida
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. (2022). 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
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