3 Nursing Interventions for Spina Bifida

Spina bifida is an anomaly in the formation of the spine, which is a defect in the closure of the spinal canal. This usually occurs in the fourth week of the embryonic period. This closure is usually a disorder of the posterior spinous processes and laminae; very rarely defects occur in the anterior portion. There is largest at the lumbar spine or lumbosacral.

Spina bifida is a general term for NTD (Neural Tube Defects) that the spinal area. The disorder is a separation of arcus vertebrae and nerve tissue underneath may or may not. (T.W.Sadler, 2010)


Etiology

1. Genetic
2. Hyperthermia, lack of folic acid and hypervitaminosis A.
3. Happen again high risk in children of mothers who had given birth with Spina bifida abnormality (TWSadler, 2010)


Pathophysiology

Pathophysiology of spina bifida easily understood when linked to measures of normal development of the nervous system. At approximately 20 days of gestation determined pressure neural groove. Sightings in the dorsal ectoderm and embryonic. During pregnancy week 4 seemed to deepen the groove quickly, leaving the boundaries of growing to the side, then the axis behind the forming neural tube. Neural tube formation begins in the cervical region near the center of the embryo and advanced caudally and cephalically direction until the end of the 4th week of pregnancy, on the front and rear neuropores closed. The main damage to neural tube defects can be due to neural tube closure.

In pregnancy week 16 and 18 formed serum alpha fetoprotein (AFP) in pregnancy so that an increase in fluid cerebro spinal AFP. Such improvements may result in leakage of cerebro spinal fluid into the amniotic fluid, then the fluid mixes with amniotic fluid AFP forming alpha-1-globulin that affect the process of cell division to be imperfect. Hence the closure of the vertebral canal defect that causes incomplete congenital failure of fusion of the dorsal folds are common in neural tube defects and exophthalmos (John Rendle, 1994).

Clinical manifestations

1. Spina bifida occulta may be asymptomatic / relating to:
a. Hair growth along the spine
b. The bottom middle indentation, usually diarea lumbosacral
c. Abnormalities of gait / foot
d. Control / poor bladder

2. Meningocele may be asymptomatic / relating to:
a. Pouch-like protrusion of the meninges and css from the back
b. Club foot
c. Gait disturbance
d. Urinary Incontinence overdo

3. Myelomeningocele relates to:
a. Protrusion of the meninges, css and spinal cord
b. Neurological deficits as high and below the exposure


Nursing Interventions and Nursing Diagnosis for Spina Bifida


1. Urinary incontinence related to visceral paralysis

Expected outcomes / Goal:
expected: the client urination normal in number and frequency.

intervention:
a. Assess the level of incontinence and voiding patterns.
b. Provide care to the client's skin wet with urine (wipe warm water then wipe dry and give the powder).
c. Instruct the client's mother to check diapers often, if wet immediately replaced.
d. Collaboration with the medical team in giving drugs (eg anticholinergics).


2. Risk for injury related to spastic paralysis

Expected Outcomes / Goal:
expected: the patient's parents know about the things that lead to injury.

intervention:
a. Teach or suggest to parents to prevent children from dangerous objects that could cause injury.
b. Demonstrate to parents that some games do not cause injury.
c. Provide health education to parents regarding drugs or handling of the first case of injury in children.
d. Provide support to children in order not to feel inferior to his condition.


3. Impaired Physical Mobility r / t the motor paralysis

Objectives:
the client is able to carry out physical activity according to ability.

Outcomes: the client can participate in an exercise program, do not happen joint contractures, increased muscle strength. The client indicates action to improve mobility.

intervention:
a. Assess existing mobility and observation of an increase in damage. Assess motor function regularly.
b. Change the client's position every 2 hours.
c. Teach the client to perform active motion exercises of the extremities that are not sick.
d. Perform passive motion on the affected extremity.
e. Maintain a 90-degree joints of the foot board.
f. Inspection of the distal part of the skin every day. Monitor the skin and mucous membranes irritation, redness or blisters.
g. Help clients perform ROM exercises. Self-care as tolerated.
h. Collaboration with physiotherapist for physical exercise.

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Care Plan and Nursing Diagnosis for Spina Bifida

Nursing Assessment for Spina Bifida

Subjective and objective data collection on the nervous system disorders, in connection with spina bifida complications depends on other vital organs. Nursing assessment of spina bifida include anamnesis, medical history, physical examination, diagnostic studies, and psychosocial assessment.

1. Anamnesis

The identity of clients includes name, age, gender, education, address, occupation, religion, nationality, date and time of hospital admission, registration number, health insurance, medical diagnostics.

The main complaint is often the reason for a client to ask for help health is the presence of signs and symptoms similar to spinal cord tumors and neurological deficits. Complaints of lumbosacral lipoma on an important sign of spina bifida.


2. History of the disease at this time

Complaints of neurological deficits can manifest as impaired motor (motor paralysis of the lower limbs) and the inferior extremity sensory and / or disorders of the bladder and the sphincter of the stomach. Complaints of unilateral foot deformity and leg muscle weakness is the most common defect. Small feet can occur trophic ulcers and pes cavus. This condition may be accompanied by sensory deficits, especially in the distribution of L3 and S1. Complaints bladder sphincter disorders are found in 25% of infants with neurological involvement, lead to urinary incontinence, urinary dripping, and recurrent urinary tract infections. Usually accompanied by the anal sphincter weakness and sensory disturbance perianal area. Neurological disorders can gradually deteriorate, especially during adolescence mass growth.


3. History of previous illness

Assessment that need to be asked include a history of the growth and development of children, history meningomyelocele ever experienced before, a history of infection subarachnoid space (sometimes chronic or recurrent meningitis), a history of spinal cord tumors, poliomyelitis, spinal developmental disabilities, such as diastematomyelia and foot deformities.


4. Assessment of psychosocial

Assessment of coping mechanisms used and the client's family (parents) to assess the response to illness and changing roles in the family and society as well as responses or influence in their daily lives either in the family or in society. Are there impacts on the client and the parents that raised fears of disability, anxiety, a sense of inability to perform activities optimally.


5. Physical examination

After making the history that led to the complaint the client physical examination is very useful to support the assessment of data from history. Physical examination should be performed by the system (B1-B6) with a focus on examining physical examination B3 (brain) directed and connected with complaints from clients.

a. The general state
In case of spina bifida generally experience loss of consciousness (GCS less than 15), especially if it occurs widely neurological deficits and changes in vital signs.

b. B1 (Breathing)
Changes in the respiratory system associated with inactivity weight. In some circumstances, the results of the physical examination found no abnormalities.

c. B 2 (Blood)
Bradycardia is a sign of changes in brain tissue perfusion. Looked pale skin indicates a decrease in hemoglobin levels in the blood. Hypotension indicates a change in tissue perfusion and early signs of a shock.

d. B3 (Brain)
Spina bifida causes a variety of neurological deficit was primarily due to the effect of increased intracranial pressure. Assessment of B3 (Brain) is a focus and a more complete examination than assessments on other systems.

e. B4 (Bladder)
In the advanced stages of spina bifida, a client may experience urinary incontinence due to confusion and inability to use the urinary system due to damage motor and postural control. Sometimes the external urinary sphincter control is lost or diminished. During this period, intermittent catheterization performed with sterile technique. Urinary incontinence that persists showed extensive neurological damage.

f. B5 (Bowel)
The presence of fecal incontinence that continues to show widespread neurological damage. Bowel examination to assess the presence or absence of bowel sounds and the quality should be assessed prior to abdominal palpation. Bowel sounds are decreased or lost may occur in paralytic ileus and peritonitis.

g. B6 (Bone)
The presence of foot deformity is one important sign of spina bifida. The most common motor dysfunction is the weakness of the lower extremities. To assess the integrity of the skin lesions and sores. Be difficult to move because of weakness, sensory loss or spastic paralysis and fatigue cause problems on the pattern of activity and rest.


6. Diagnostic tests

Spine x-rays to identify any defect in the spine, usually occurs in the posterior arch of the vertebra in the spine midline amount varies. The presence of spinal dyspropism or widening of the spine is a typical sign of radiology at the lumbar (Perkin, 1999).



Nursing Diagnosis for Spina Bifida

1. Urinary incontinence r / t paralysis visceral

2. Risk for injury r / t spastic paralysis

3. Impaired Physical Mobility r / t motor paralysis

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