7 Spina Bifida Nursing Care Plans

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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 Plans

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:

  1. Hypothermia
  2. Impaired Urinary Elimination
  3. Bowel Incontinence
  4. Disturbed Body Image
  5. Interrupted Family Processes
  6. Risk for Infection
  7. Risk for Injury
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Interrupted Family Processes

Interrupted Family Processes: Change in family relationships and/or functioning.

May be related to

  • Situational crisis of long-term condition of child

Possibly evidenced by

  • Inability to express or accept wide range of feelings
  • Excess involvement with child by family members
  • Family system unable to meet physical, emotional needs of its members
  • Family unable to deal with or adapt to chronic condition and disabilities of child in a constructive manner
  • Guilt expressed by family members
  • Irritability and impatience as a response by family members to child
  • Lack of support from family and friends

Desired Outcomes

  • Family will adapt to child’s disability and begin to move forward
Nursing InterventionsRationale
Assess anxiety level of family and child, perception of crisis situation, coping and problem-solving methods used and effectiveness.Identifies the need to develop new coping skills and realistic behaviors in goal setting and interventions necessary for family and child to adapt crisis.
Assess family ability to cope with the child, developmental level of family, stress on family relationships, response of siblings, knowledge of health practices, family role behavior and attitude about long-term care, economic burdens, resources to care for long-term condition and grieving process, signs of depression, feelings of powerlessness and hopelessness.Provides information about family attitudes and coping abilities that directly affect the child’s health and feeling of well-being; chronic condition affecting a child in a family may strengthen or strain relationships and members may develop emotional problems when the family is stressed.
Encourage family members to vent feelings and reaction to appearance and condition of infant/child.Relieves anxiety and concern and allows a show of acceptance for their responses.
Encourage expression of feelings and provide accurate, honest information about care with or without surgical repair, abilities, and disabilities.Allow reduction in anxiety and enhances family understanding of condition and child’s needs.
Encourage to maintain the health of family members and social contacts.Prevents adverse effect of chronic anxiety, fatigue, and isolation on health and care capabilities of family.
Communicate empathy for client and family.Promotes coping and positive adjustment to illness.
Support and encourage parental and family caretaking efforts.Provides positive reinforcement of roles and reduces stress in family members.
Provide anticipatory guidance for crisis resolution.Assists family to adapt to the situation and develop a new coping mechanism.
Be aware of cultural differences in coping behaviors; need differs according to cultural and ethnic backgrounds.Promotes cultural and developmental normalcy.
Assist to discuss family dynamics and need to tolerate conflict and individual behaviors.Assists to understand the family members leading to resolution.
Assist to identify helpful techniques to use to problem solve and cope with the problem and gain control over the situation.Provides support for problem solving and management of the situation.
Assist family with identifying realities of disabilities and suggest contact with community agencies, clergy, social services, physical and occupational therapy.Provides support, information, and assistance.
Teach that overprotective behavior may hinder growth and development, and that child should have limits and rules to live by.Enhances family understanding of the condition and need for integration of the child into family activities.
Reinforce positive coping behaviors.Promotes behavior change and adaptation to care for the child.
If hospitalization frequent, assign same personnel to care for the child if appropriate.Promotes trust and communication with family members.
Explain causes, treatment, and prognosis of condition; inform parents that they are not at fault for development of the congenital defect.Reduces guilt and provides information about the condition.
Advice parents that surgery may be performed within 48 hours after birth or be postponed to the age of 3 months or until a further neurologic function is assessed, to allow for better epithelialization to occur, and to reduce the possibility of the development of hydrocephalus; use this information as reinforcement of physician information.Provides information to assist the family in the decision about the surgical procedure.
Inform need for follow-up appointments with physician and therapists.Ensures compliance with the medical regimen.
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See Also

You may also like the following posts and care plans:

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:

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