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
May be related to
- Neuromuscular involvement
Possibly evidenced by
- Constant dribbling or involvement passage of stool
- Poor anal sphincter tone and control
- Impaired skin integrity caused by continuous contact with liquid stool
- Child will participate in bowel control regimen.
- Child will be able to control elimination.
|Assess presence of neurogenic bowel, the degree of incontinence, the potential for rehabilitation.||Provides information about the condition for use in the plan of establishing bowel elimination routine.|
|Place child on a toilet or potty chair at the same time each day; use stimulation and suppository if needed.||Establishes a routine for elimination to empty bowel.|
|Teach parents on correct cleansing and diapering techniques of infant/toddler.||Promotes understanding to maintain good skin integrity.|
|Change diapers as quickly as feasible; cleanse perianal area carefully.||Dry, clean skin resist breakdown.|
|Apply barrier creams as prescribed to the perianal area during diapering.||Prevents skin breakdown.|
|Suggest clothing and undergarments to protect from staining accidents.||Promotes self-image and prevents embarrassing incidents.|
|Apply padding in waterproof undergarments but avoid the use of diapers.||Prevents embarrassment for the child if bowel elimination not controlled.|
|Encourage fluid intake of up to 2,000 ml/day depending on age; include fiber and roughage in the diet.||Promotes bulk for easier and more manageable passage.|
|Teach parents and child about program for control of bowel incontinence (fluids, diet, routine toileting, use of stimulation).||Promotes success in bowel training.|
|Teach about behavior modification as a method to be used for bowel rehabilitation.||Promotes compliance with the routine to control bowel incontinence.|
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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