Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida

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Outline

Pathophysiology

A neural tube defect is a birth defect of the brain, spine and spinal cord. In Spina Bifida, the spinal vertebrae do not fully form and close to protect the spinal cord, leaving an opening along the spinal column. There are three types of spina bifida: spina bifida occulta is the mildest form of the defect in which there are gaps in the spine, but no opening on the back; meningocele is when a sac of fluid protrudes from an opening in the spinal column, but the spinal cord is not affected; myelomeningocele is when part of the nerves and spinal cord protrude through an opening in the spinal column. Myelomeningocele is the most severe and results in the greatest disabilities involving motor function, sensation and ability to move or control extremities.

Etiology

Genetics and some lifestyle factors such as drug use and improper nutrition of the mother affect the development of spina bifida in a fetus. It is suspected that a folic acid deficiency during the early stages of pregnancy may contribute to the risk of neural tube defects. Other risk factors include uncontrolled maternal diabetes, exposure to chemicals or toxins during pregnancy, and becoming overheated during pregnancy.

Desired Outcome

Patient will have optimal motor function; patient will be free from infection; patient will be free from injury

Subjective Data:

  • Muscle weakness
  • Lack of sensation

Objective Data:

  • Abnormal tuft of hair or dimple on back 
  • Protrusion of a sac from an opening in the spinal column 
  • Lack of movement in lower extremities 
  • Urinary or fecal incontinence later in life (lack of control)

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Perform newborn assessment, APGAR score and physical examination Observe for presence of abnormalities or physical defects.

Note spinal column, abnormal tufts of hair or dimples on infant’s back that indicate a closed neural tube defect or spina bifida occulta.

Assess and monitor vital signs Gather baseline information, monitor for changes or signs of complications. Autonomic instability is possible with spinal cord involvement.
Apply moist, sterile dressing over sac. Provide dressing care as needed and per facility protocol Moist dressings prevent drying of the sac that can cause rupture and risk infection.
Assess temperature and signs of infection. Assess for irritation, redness, swelling or drainage around the sac. Exposure of a fluid sac or spinal cord through opening in the skin increases risk of bacterial infection
Perform careful handling during nursing care. Change process of care activities as appropriate Be careful to avoid trauma to the sac to prevent further damage to the spinal cord
Provide pre- and post- surgical care Surgical site care should be done using sterile technique following surgery to prevent infection.
Administer medications appropriately Antibiotics may be given empirically to prevent infections.

Antispasmodics and anticholinergics may be given to help bladder incontinence.

Assess bowel and bladder function Note the presence of neurogenic bladder and amount of incontinent care required.

Insert urinary catheter, provide catheter care, monitor urine output.

Provide incontinence care as required Perform intermittent catheterization as required. 

Can educate older patients to self-catheterize

Assist with bladder emptying as necessary (Crede’s maneuver).

Provide bowel and skin care to prevent skin breakdown

Provide range of motion exercises Promote strengthening and prevent contractures and atrophy of muscles
Provide assistance with assistive devices for mobility Patient may require splints, braces, wheelchair or other devices as he/she grows according to level of disability.
Provide resources and education for parents / caregivers Resources

Home care

Relieve anxiety

Provide emotional support for care of patient. Relieve some stress by providing education and access to resources.

 

Writing a Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida

A Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey everyone, today, we’re going to be putting together a nursing care plan for a neural tube defect, spina bifida. So, let’s get started first. We’re going to go over the pathophysiology. So, a neural tube defect is a birth defect of the brain spine and spinal cord is spina bifida. The spinal vertebrae do not fully form and close to protect the spinal cord, leaving an opening along the spinal column. Nursing considerations: we want to do a newborn assessment, vital signs, dressing changes, administer medications, pre and post-surgical care. Desired outcomes: the patient will have optimal motor function. The patient will be free from infection, and the patient will be free from injury. And so here is an example of what spina bifida is. You’ll notice how that sac is on the outside of the body. So, you’re going to have the dura mater here. That’s the spinal cord right here and the spinal fluid. That’s on the inside here and it’s just going to be exposed to the outside. 

Alright, we’re going to get into the care plan. We’re going to find some subjective data and some objective data that we’re going to write here. So, when a patient with spina bifida, what are you going to see in these patients? They’re going to have some muscle weakness. One of the classics for spina bifida, you’re going to have an abnormal hair or dimple on the back. That is classic. You’re going to have that protrusion of the sac. So, you’re going to have that lack of sensation, that protrusion of the sac of the opening of that spinal column you saw in that picture, lack of movement in the lower extremities, and you’re going to have urinary or fecal incontinence later in the life, or a lack of control. 

So, interventions, we want to make sure we’re going to perform a newborn assessment and do vital signs. So, you want to do a proper assessment and vital signs. We’re going to be looking for temperature, going to make sure that we’re doing that Apgar score and a physical examination. We’re going to be observing for the presence of abnormalities or physical defects. We want to note the spinal column, any abnormal toughs of hair or dimples on the infant’s back that indicate a neural tube defect or spinal bifida. You want to gather baseline information you want to monitor for changes and signs of any sort of complications. Elevated temperature can be a sign of infection. So, you want to assess for any sort of irritation, redness, swelling, or drainage that may be around that sac; exposure of fluid sac or spinal cord through that opening and the skin increases the risk of bacterial infection. Another intervention we want to do is we want to make sure that we’re applying moist, sterile dressing over that sac. We want to make sure we’re providing dressing care as needed or per the facility protocol. Those moist dressings are going to help prevent drying of that sack that can cause rupture and or risk of infection. Another intervention we want to do, we make sure that we are performing careful handling during nursing care. Any change in the process of care activities as appropriate. We want to just make sure we’re careful to avoid any sort of trauma to that sac and able to prevent any further damage to the spinal cord. Another intervention we are going to do, we want to provide any range of motion exercises, range of motion exercises or assistive devices. So, we want to promote strengthening and preventing contractures and atrophy of those muscles. Some patients may require some splints, braces, wheelchair, or any other devices that they may need as they grow. Another intervention is administering medications as needed, and that could be antibiotics for preventing infection, to antispasmodics or anticholinergics to help with bladder incontinence. We want to make sure we’re providing pre and post-surgical care. So, the surgical site care should be done using sterile technique to prevent any sort of infection. 

Alright, we’re going to go over the key points. So, spina bifida, is a birth defect of the brain, spine, and spinal cord. The spinal vertebrae do not fully form and close to protect the spinal cord, leaving it open. Causes include genetics, lifestyle factors, or improper nutrients. Some subjective and objective data that you’ll see with these patients. They’ll have some muscle weakness, lack of sensation, that tough of hair or dimple on the back, lack of movement in the lower extremities, urinary or fecal incontinence, protrusion of that sac. These ones are classic here. We want to make sure we’re doing that newborn assessment, check vital signs, and provide the appropriate dressing changes. Post-surgery we want to do those range of motion exercises, mobility devices, making sure that they have access to those and administering medications. Alright. And that’s the end of that care plan, guys. You did amazing.

We love you guys. Go out, be your best self today, and as all ways, happy nursing.

 

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