How is Spina Bifida diagnosed?
1. AFP levels in blood 16-18 weeks of gestation
2. If AFP elevated, amniocentesis and fetal ultrasound are performed.
Spina Bifida Occulta
A vertebral defect w/no visible protrusion of the meninges or spinal cord tissue (dimple, tuft of hair, or hemangioma)
Spina Bifida Cystica
A sac-like protrusion in the lumbar or sacral area, caused by an incomplete closure of the vertebrae
Spina Bifida Cystica- Meningocele
Sac-like protrusion is filled w/spinal fluid & meninge
Spina Bifida Cystica- Myelomeningocele
Most severe form- assoc. w/hydrocephalus; Sac is filled w/spinal fluid, meninges, nerve roots, & spinal cord
Assoc. disabilities w/Myelodysplasia
1. Mobility Pxs
2. Cognitive Impairment
3. Seizure Disorders
4. Visual Impairment (strabismus)
5. Skin Sores
6. Spinal Curvatures
7. Urinary & Sexual Dysfunction
8. Latex Allergy
How do neural tube defects occur?
w/i one month of conception; can be caused by folic acid deficiency, certain acne or seizure meds.
What is involved in the newborn with Spina Bifida?
1. Sac for integrity/leakage of CSF
2. Extremities for deformities
3. VS for s/of infection
4. Strict I&O's w/a foley catheter
Post-op interventions for Spina Bifida
1. Observe wound healing for signs of infection, CSF leakage
2. Head circumference daily to assess for hydrocephalus
Indicative of CSF leakage
Yellow "halo" on gauze pad (glucose ring)
Signs of infection in Spina Bifida?
1. Redness or clear/purulent drainage on the sac
2. High temp
3. Increased WBC's
Signs of a meningeal infection?
1. Altered neurological signs
3. Full fontanel
Planning and Implementation for Spinal Bifida Pre-op?
1. Cover the sac w/sterile saline dressing (facilitates healing and decreases a risk for infection)
2. Monitor for CSF leak (clear or purulent drainage, yellow halo ring)
3. Position pt in prone or side-lying position (with small blanket/diaper roll under ankles and between the knees)
4. Assess for motor deficits of esp bladder and bowel involvement
Signs of urinary deficits
1. Urinary dribbling
2. Foul-smelling urine
3. Cloudy urine
Planning and Implementation for Spinal Bifida Post-op?
1. Monitor vs and for s/s of infection
2. If VP shunt, monitor for hydrocephalus, increased ICP, or infection
3. Assess surgical site for CSF leakage
4. Prone or side-lying position must be maintained for proper healing
5. Keep diaper away from incision
Spina Bifida Child Assessment
1. VS, growth, and head circumference
2. Neuro status
3. ROM of joints and mobility status
Post-op Spina Bifida Child Assessment
1. VS, responsiveness, and pain level
2. Dressing sites for bleeding and draining
3. Distal extremities for swelling, circulation, and sensation
4. Strict I&O's w/a Foley catheter