Spina Bifida Research Paper

Spina Bifida
VNSG 1330-001
Instructor:
June 14, 2014
St. Philip’s College

When the spine has not completely developed in the womb, it is referred to as spina bifida (split spine). There are two types of spina bifida: spina bifida occulta and spina bifida cystica. Spina bifida occurs during “the end of the first month of pregnancy when the two sides of the embryo’s spine fails to join together, leaving an open area”; this is a neural tube defect (Kids Health). This is usually noticed before the birth the baby and is treated right away. No one knows the true cause of this condition. Scientists believe that genetics and environmental factors could play a role. It is considered the most common birth defect in the United
States. Spina bifida occulta, also known as hidden spina bifida, is the milder version of spina bifida; a layer of skin covers the defect.
This form does not cause any visible signs or health problems and can go undetected. Ten to twenty percent of healthy people have it and don’t realize it. It’s usually discovered when a person gets an x-ray of their back for another reason, unrelated to this condition. A small percentage of people will have pain and neuromuscular problems. These symptoms could be “progressive disturbances of gait, such as footdrop, or disturbances of bowel and bladder sphincter function” (Leifer). There may also be a dimple or small patch of hair on the lower
back. Spina bifida cystica is classified as “a cystic mass in the midline of the opening in the spine” (Leifer).
There are two variations of this defect: meningocele and meningomyelocele. Meningocele causes a portion of the spinal cord to push through the spine which forms a sac and is noticeable on the back. The sac is filled with nerve fluid but there is usually no nerve damage. In most cases, people live with few symptoms and sometimes none at all but in others it can cause “incomplete paralysis with bladder and bowel dysfunction” (NIH). Meningomyelocele is the most severe form of spina bifida. The meninges and the spinal cord push through the opening in the spine which causes nerve damage and additional disabilities. “Seventy to ninety percent of children with this condition also have too much fluid on their brains” (SBA). The fluid from the brain and spinal cord are unable to drain like normal and can lead to swelling and pressure that can cause permanent brain damage. Even though the cause of spina bifida is unknown, some believe that the use of drugs and poor nutrition during the early stages of pregnancy can contribute to this defect. It is recommended “that all women of childbearing age take a daily multivitamin that contains 0.4 mg of folic acid and continue the intake of folic acid until the 12th week of pregnancy, when basic neural tube development is completed” (Leifer). Women need to be educated on the importance of taking folic acid before and during
pregnancy. There are no medications directly involved in the treatment of spina bifida. The main course of treatment is surgery. Meningomyelocele requires surgery to be performed between 24 and 48 hours after birth. If surgery is performed early, infection will have less time to set in and it reduces the amount of trauma on the spinal cord. Spina bifida worsens after birth, so some doctors recommend having prenatal surgery to repair the spinal cord. Although this procedure is risky, “children who received the fetal surgery need fewer shunts, and are less likely to need crutches or other walking devices” (Mayo). Surgery is not the final treatment for this condition. Physical therapy will play a major role in the child’s life. Braces and crutches may be used when a child gets older and they are learning to walk. Most children can grow to live normal full lives if it is treated early. The major goals of nursing care are “prevention of infection of or injury to the sac, correct positioning to prevent pressure on the sac and development of contractures, good skin care (particularly if the infant is incontinent of urine and feces), adequate nutrition, accurate observations and charting, education of the parents, continued medical supervision, and habilitation” (Leifer). If surgery is not going to be performed right away, the doctor may order saline covered sterile dressings to prevent the sac from drying out. It is important for the nurse to observe the size of the sac and to check for any tears. The legs and arms should be observed for movement and the circumference of the head it measured “to determine the possibility of associated hydrocephalus” (Leifer). Placing an infant in the prone position avoids pressure on the sac. A pad should be placed in the middle of the legs to continue abduction. The development of a latex allergy is common in infants with spina bifida and the doctor may prescribe antihistamines or steroids. It is important that the environment around the infant is free of latex. If the infant develops a latex allergy, teach the parents that anything with latex should be avoided. Teach the parents to read labels carefully when selecting toys, pacifiers, or any other product their child may come into contact with. Inform them that it can cause a rash and make the child wheeze. Teach them about the foods they should avoid; “bananas, avocados, and kiwi” (Leifer). At first, the parents may feel overwhelmed and scared. It is important for the parents to know that they’re child will need physical therapy but that they can grow up to live a normal, full life. As a nurse it is important to be supportive towards the parents.