SPINA BIFIDA

ANATOMY AND PHYSIOLOGY

Spina bifida, also called spinal dysraphia, is a malformation of the spine in which the posterior portion of the laminae of the vertebrae fails to close. It occurs in approximately 1 per 1,000 live births in the United States and is the most common developmental defect of the central nervous system (CNS). It is more common in Caucasian than in nonCaucasian people.

(A) Normal spine. (B) Spina bifida occulta. (C) Spina bifida with meningocele. (D) Spina bifida with myelomeningocele.

Spina Bifida Occulta

The defect is only in the vertebrae. The spinal cord and meninges are normal.

Meningocele

The meninges protrude through the opening in the spinal canal. This forms a cyst filled with CSF and covered with skin.

Myelomeningocele (or Meningomyelocele)

The spinal cord and cord membranes protrude through the defect in the laminae of the vertebral column. Myelomeningoceles are covered by a thin membrane.

PHYSIOLOGY

1. Unknown physiology but generally thought to result from genetic predisposition triggered by something in the environment

A. Certain drugs, including valproic acid, have been known to cause neural tube defects if administered during pregnancy.

B. Women who have spina bifida and parents who have one affected child have an increased risk of producing children with neural tube defects.

2. Involves an arrest in the orderly formation of the vertebral arches and spinal cord that occurs between the fourth and sixth weeks of embryogenesis.

3. Theories of causation include:A. There is incomplete closure of the neural tube during the fourth week of

embryonic life.

B. The neural tube forms adequately, then ruptures.

4. In spina bifida occulta, the bony defect may range from a very thin slit separating one lamina from the spinous process to a complete absence of the spine and laminae.

A. A thin, fibrous membrane sometimes covers the defect.

B. The spinal cord and its meninges may be connected with a fistulous tract extending to and opening onto the surface of the skin.

5. In meningocele, the defect may occur anywhere on the cord. Higher defects (from thorax and upward) are usually meningoceles.

A. Surgical correction is necessary to prevent rupture of the sac and subsequent infection.

B. Prognosis is good with surgical correction.

6. In myelomeningocele (meningomyelocele), the lesion contains both the spinal cord and cord membranes.

A. A bluish area may be evident on the top because of exposed neural tissue.

B. The sac may leak in utero or may rupture after birth, allowing free drainage of CSF. This renders the child highly susceptible to meningitis.

C. Occurs four to five times more frequently than meningocele.

NURSING CARE PLAN

Protecting Skin Integrity

ASSESSMENT

Cues/ Clues

(Subjective/ Objective

Data)

NURSING DIAGNOSIS

(Nursing Problem)

PLANNING

(Nursing Objective/ Goal/ Outcome

Criteria)

NURSING

INTERVENTION

RATIONALE EVALUATION

Subjective Data:

“Namamaga na ang parting

likod ng baby.” As verbalized by the mother

Objective Data:

- red skin with abscess

Ineffective peripheral tissue perfusion related to decreased arterial flow as evidenced by decreased pulses, pale cool feet ,brittle nails, and edema due to wound with abscess

Possible infection of the wound aeb the presence of abscess

STO:

After 2 hour of duty the mother will be able to know several procedures in protecting the skin and managing the condition

LTO:

After end of duty the mother knows several interventions to protect skin integrity

1. Avoid positioning on the infant's back to prevent pressure on the sac. Check position at least once every hour.

2. Observe the sac frequently for evidence of irritation or leakage of CSF.

3. Use prone positioning with hips only slightly flexed to decrease tension on the sac.

4. Place a foam rubber pad covered with a soft cloth between the infant's legs to maintain the hips in abduction and to prevent or counteract subluxation. A diaper roll or small pillow may be used in place of the foam rubber pad.

5. Allow the infant's feet to hang freely

Compromised circulation and decreased pain sensation may precipitate or aggravate tissue break down .

It increase metabolic demands on compromised tissues. Vascular insufficiency/alterspain

After 80 of duty, she had demonstrated awareness of safety factor and proper foot care for the baby and lessen the swelling.

over the pads or mattress edge to prevent aggravation of foot deformities.

6. Provide meticulous skin care to all areas of the body, especially ankles, knees, tip of nose, cheeks, and chin.

7. Provide passive ROM exercises for muscles and joints that the infant does not use spontaneously. Avoid hip exercises because of common hip dislocation, unless otherwise recommended.

sensation, increasing risk for injury.

Altered perfusion of lower extremities may lead an serious and persistent complication at the cellular level.

PATHOPHYSIOLOGYOF

INCOMPLETE ABORTION

Blood collects between the chorionic membrane(a membrane that develops around a fertilized egg) and the wall of the uterus

8 weeks AOG

During egg implantation, egg slightly separates or tears from the

uterus

Blood leaks in the cervix

Mild Uterine Cramping and Minimal vaginal spotting/bleeding

Subchorionic Hemorrhage

Severe SC bleeding can lead to rupture of the subchorionic

membrane

Risk for Miscarriage & Stillbirth

(THREATENED ABORTION)