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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