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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Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

May be related to

  • Bacterial invasion of the neural tube sac
  • Inadequate primary defenses (broken skin, inadequate bladder emptying)

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child will not experience infection as evidenced by
Nursing InterventionsRationale
Assess neural tube sac for breaks or leakage of CSF, irritation of sac, redness, swelling, purulent drainage at or around sac area; Assess for fever, irritability, nuchal rigidity, cloudy foul-smelling urine.Gives information about the potential for infection of the sac site, meningitis if the sac is ruptured, or is present.
Do handwashing before or after procedures involving the site and maintain sterile technique when caring for the client.Avoids the proliferation of microorganisms to the site.
Use sterile saline or antibiotic solution as prescribed to make sure a moist sterile dressing is applied over the sac.Avoids the sac membrane to be dried that could result to sac breakage and contamination.
Reinforce moist dressing with dry sterile dressing and change as needed; Remove moist dressing after it has dried to avoid damage to sac.Prevents contamination by capillary action through moisture.
Apply shield over the sac dressing and tape a plastic sheet below the defect; following surgical closure on the defect, apply a transparent occlusive dressing over the area below the sac site.Protects the sac from urine or fecal contamination.
Keep anal area clean and apply a sterile shield between anus and sac.Prevent fecal contamination caused by poor anal sphincter control which allows for dribbling and incontinence of stool.
Avoid ureteral contamination with stool, perform thorough perianal hygiene as needed.Prevents urinary tract infection.
Teach parents to cleanse the sac gently with moist cotton balls if soiled, avoid diapering the infant until after surgery and healing has taken place.Protects sac from contaminants and maintains cleanliness.
Alter routine nursing care activities such as feedings, changing linens and comforting as needed.Prevents trauma to sac.
Following surgical repair of the defect, observe any changes in wound including redness, swelling, warmth, drainage, fever.Indicates wound infection.
Following surgery, cleanse wound with antiseptic as ordered and change dressings when needed using sterile technique for at least 24 hours.Promotes cleanliness of wound and prevents infection.
Maintain the infant in a prone position or side-lying, as permitted, with head lower than buttocks or hips slightly flexed with a pad between the knees; anchor position with sandbags.Reduces pressure on the sac to prevent possible rupture and prevents rolling on side or back.
Administer antibiotics as ordered.Antibiotics are prescribed to help prevent  urinary infections
Teach parents about proper positioning infant and application of protection around sac such as foam rubber doughnut.Prevents damage to the sac and possible infection.
Handle infant gently, hold and support back above the defect, or place on a pillow in prone position to move from place to place.Prevents pressure on the sac area.
Teach parents about signs and symptoms of infection on the surgical site, and notfiy health care provider accordingly.Promotes early detection of an infectious process for early treatment.
Stress the importance of handwashing, dressing change, use of clean or sterile linens, gloves, supplies when caring for sac area.Prevents transmission of infectious organisms; sterile technique may not be needed in giving care after surgery is performed.
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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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