Spina bifida involves the failure of the neural tube to develop or close during embryonic development causing defects in the spinal cord and in the bones of the spine. There are two types of spina bifida: spina bifida occulta is the most common and is a defect in the closure without the herniation and exposure of the spinal cord or meninges at the surface of the skin in the lumbosacral area. While spina bifida cystica (meningocele or myelomeningocele) is a defect in the closure of a sac and herniated protrusion of meninges, spinal fluid and possibly some part of the spinal cord and nerves at the surface of the skin in the lumbosacral or sacral area.
Hydrocephalus is often related with spina bifida cystica. The extent of neurologic impairment are associated to the location and nerves involved in the defect and range from varying degrees of sensory deficits, to partial or total loss of motor function resulting in flaccidity, partial paralysis of lower extremities, and bowel and urinary incontinence.
There are several different treatments that can be used to manage symptoms or conditions associated with spina bifida such as surgery to close the opening in the spine which may be done during infancy or later, physiotherapy, speech and occupational therapy, use of assistive devices and mobility equipment, such as a wheelchair, or walking aids, and urinary and bowel management.
Nursing care planning goals for clients with spina bifida include prevent infection, maintain skin integrity, prevent trauma related to disuse, increase family coping skills, education about the condition, and support.
Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for spina bifida:
- Impaired Urinary Elimination
- Bowel Incontinence
- Disturbed Body Image
- Interrupted Family Processes
- Risk for Infection
- Risk for Injury
Impaired Urinary Elimination
Impaired Urinary Elimination: Disturbance in urinary elimination.
May be related to
- Neuromuscular defect
Possibly evidenced by
- Urinary retention
- Urinary incontinence
- Neurogenic bladder with increased or decreased tone
- Passing of urine or ability to stop flow of urine
- Lack of awareness of bladder fullness
- Child will have improved urinary elimination by school age.
|Assess urine for color, amount, odor, and turbidity.||Cloudy, dark, bloody, or strange-smelling urine indicates urinary bladder infection caused by urinary retention.|
|Assess presence of neurogenic bladder, the degree of incontinence, potential for rehabilitation, age of the child.||Provides information about the condition for use in the plan of establishing urinary elimination routine.|
|Keep the genital and anal area clean after each elimination episode or as needed if incontinent.||Prevents the introduction of microorganisms into the urethra and urinary bladder.|
|Encourage adequate fluid intake of 30 ml/1lb/day including acid-containing beverages and addition of foods high in acid content in the diet.||Promotes renal blood flow and acidifies urine to prevent infection.|
|Encourage parents to use pad and water-proof undergarment instead of the use of diapers for a child over 3 years of age.||Prevents an embarrassment for the child.|
|Perform scheduled rehabilitation program of placing the child on toilet or potty chair at same times each day.||Establishes a routine for urinary elimination if this is a possibility.|
|Perform intermittent catheterization every 3 to 4 hours if indicated to resolve incontinence.||Ensures emptying of the bladder to prevent incontinence and infection.|
|Perform Crede’s maneuver if indicated.||This is done by exerting manual pressure on the abdomen at the location of the bladder that promotes emptying of the bladder.|
|Educate parents and age-dependent child in the use of external urinary device or procedure for intermittent self-catheterization; demonstrate and provide a return demonstration.||Provides a method for emptying bladder routinely or managing incontinence by use of collecting device connected to a closed system.|
|Administer the following medications as indicated:||These medications improves bladder storage and continency by increasing bladder action.|
|Advise parents on alternative procedures to control incontinence such as implantation of an artificial sphincter, creation of an artificial reservoir, or creation of a urinary diversion.||Provides information about other methods that can be performed if intermittent catheterization is not attained.|
|Educate parents and child about changes in urine characteristics indicating bladder infection and measures to take to prevent this complication.||Allows for early interventions to control infection and eventual renal complications.|
|Advice to keep a record on fluid intake/day, weights and changes to report foods and fluids that are acidic including meat, poultry, fish, citrus fruits, pasta, dairy, eggs, grains.||Maintains a monitoring system to ensure control of possible complications.|
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Maternal and Newborn Care Plans
Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:
- Abruptio Placenta| 3 Care Plan
- Cesarean Birth | 10 Care Plans
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperbilirubinemia | 4 Care Plans
- Labor Stages, Induced and Augmented Labor | 36 Care Plans
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 4 Care Plans
- Prenatal Hemorrhage | 7 Care Plans
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Pregnancy Induced Hypertension | 6 Care Plans
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 6 Care Plans
- Puerperal Infection | 4 Care Plans